MEDICARE: DR. STEPHEN ALAN RAPHAEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	04068142	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0048146000	OTHER	PA	IBC PROVIDER ID
2	087602	OTHER	PA	HIGHMARK BC PROVIDER ID

General Provider Information

NPI Number	:	1710989405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ALAN RAPHAEL MD

Provider Business Mailing Address
First Line	:	409 2ND AVE
Second Line	:	SUITE 301
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3625
Country	:	US
Telephone Number	:	610-409-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 2ND AVE
Second Line	:	SUITE 301
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3625
Country	:	US
Telephone Number	:	610-409-8830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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