Provider Demographics
NPI:1225072549
Name:STEPHEN D. RAPHAEL M.D. P.A.
Entity Type:Organization
Organization Name:STEPHEN D. RAPHAEL M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-429-6267
Mailing Address - Street 1:303 HADDONFIELD BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1412
Mailing Address - Country:US
Mailing Address - Phone:856-429-6267
Mailing Address - Fax:856-429-2445
Practice Address - Street 1:303 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1412
Practice Address - Country:US
Practice Address - Phone:856-429-6267
Practice Address - Fax:856-429-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2198304NJMedicaid
NJC53697Medicare UPIN
NJ073144Medicare ID - Type Unspecified