MEDICARE: OCEAN CITY FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	MB048583	NJ

General Provider Information

NPI Number	:	1811183189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN CITY FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-399-1572

Provider Business Practice Location Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-399-1572

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. GARY WILLIAM RAAB
Credential	:	DO.
Telephone Number	:	609-399-1862

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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Directions to “OCEAN CITY FAMILY PRACTICE ” Practice Location

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