Provider Demographics
NPI:1215023148
Name:VARGAS, RAFAEL ANTONIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:VARGAS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:18 LAPIDUM RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1504
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:410-642-1884
Practice Address - Street 1:BUILDING 364A
Practice Address - Street 2:PERRY POINT VA MEDICAL CENTER
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1884
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant