Provider Demographics
NPI:1073055745
Name:MARCANTONIO, RAFFAELLA MARIA (ND)
Entity Type:Individual
Prefix:DR
First Name:RAFFAELLA
Middle Name:MARIA
Last Name:MARCANTONIO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1002
Mailing Address - Country:US
Mailing Address - Phone:716-873-8700
Mailing Address - Fax:716-873-8701
Practice Address - Street 1:3734 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1002
Practice Address - Country:US
Practice Address - Phone:716-873-8700
Practice Address - Fax:716-873-8701
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1173175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath