Provider Demographics
NPI:1225235252
Name:MAGANA, RAFAEL GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:GERARDO
Last Name:MAGANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 E PUTNAM AVE STE AB
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2600
Mailing Address - Country:US
Mailing Address - Phone:347-767-6653
Mailing Address - Fax:646-304-0404
Practice Address - Street 1:40 E PUTNAM AVE STE AB
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2600
Practice Address - Country:US
Practice Address - Phone:888-501-5274
Practice Address - Fax:646-304-0404
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239015208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT54185OtherCT STATE LICENSE
NY239015OtherNYS LICENSE