Provider Demographics
NPI:1164525853
Name:CROITORU, RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:CROITORU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W IOWA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6814
Mailing Address - Country:US
Mailing Address - Phone:208-467-3432
Mailing Address - Fax:208-467-4147
Practice Address - Street 1:222 W IOWA AVE STE A
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6814
Practice Address - Country:US
Practice Address - Phone:208-467-3432
Practice Address - Fax:208-467-4147
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5744207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID820451495OtherTAX I.D. NUMBER
ID000010004790OtherREGENCE BLUE SHIELD OF ID
ID002701100Medicaid
ID57448OtherBLUE CROSS OF IDAHO
ID57448OtherBLUE CROSS OF IDAHO
ID000010004790OtherREGENCE BLUE SHIELD OF ID