Provider Demographics
NPI:1073539276
Name:GRACIA, RAFAEL IVAN (MD)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:IVAN
Last Name:GRACIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 LITTLE POND COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2810
Mailing Address - Country:US
Mailing Address - Phone:401-787-7798
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:CCBC
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-823-5400
Practice Address - Fax:508-880-7114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA579742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry