MEDICARE: DR. THEODORE RAFAEL M.D.

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	207U00000X	Nuclear Medicine Physician	217476	NY
2	2085R0202X	Diagnostic Radiology Physician	217476	NY

General Provider Information

NPI Number	:	1740283233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE RAFAEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 253
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10602-0253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 GRASSLANDS RD
Second Line	:	WESTCHESTER MEDICAL CENTER - DEPT OF RADIOLOGY
City	:	VALHALLA
State	:	NY
Zip	:	10595-1652
Country	:	US
Telephone Number	:	914-493-8881
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/13/2013

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