Provider Demographics
NPI:1184181638
Name:WILLIAMS, RAFIAH
Entity Type:Individual
Prefix:
First Name:RAFIAH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712B W YORK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3511
Mailing Address - Country:US
Mailing Address - Phone:215-690-1044
Mailing Address - Fax:215-701-6568
Practice Address - Street 1:2712B W YORK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3511
Practice Address - Country:US
Practice Address - Phone:215-690-1044
Practice Address - Fax:215-701-6568
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103559656-0001Medicaid