Provider Demographics
NPI:1154446078
Name:RAFFERTY, KAREN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:HADAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7955 SPYGLASS HILL RD
Mailing Address - Street 2:STE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8249
Mailing Address - Country:US
Mailing Address - Phone:207-214-5698
Mailing Address - Fax:321-775-1364
Practice Address - Street 1:1255 37TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-299-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI08622207L00000X
FLME 109681207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005922000Medicaid
FL14K3XOtherBLUE CROSS BLUE SHIELD
FL14K3XOtherBLUE CROSS BLUE SHIELD
FLHK439AMedicare PIN
FZ329XMedicare PIN