Provider Demographics
NPI:1184828766
Name:RAPOSE, ALWYN NONESUPPLIED (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ALWYN
Middle Name:NONESUPPLIED
Last Name:RAPOSE
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3122
Mailing Address - Fax:508-368-3121
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 220 S
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3122
Practice Address - Fax:508-368-3121
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220789207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2805580781OtherMYUTMB 2805580781-COMMERCIAL NUMBER
MA215508Medicaid
MA215508Medicaid