Provider Demographics
NPI:1003862988
Name:BHADELIA, RAFEEQUE A (MD)
Entity Type:Individual
Prefix:
First Name:RAFEEQUE
Middle Name:A
Last Name:BHADELIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1806
Mailing Address - Country:US
Mailing Address - Phone:617-754-2058
Mailing Address - Fax:617-754-2004
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BIDMC WCC90
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-754-2058
Practice Address - Fax:617-754-2004
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA789732085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3161391Medicaid
MAA21927Medicare ID - Type Unspecified
MAG38444Medicare UPIN