Provider Demographics
NPI:1235201120
Name:OLDAN, RAQUEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:L
Last Name:OLDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:LOZDZIEJSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:243 W 70TH ST
Mailing Address - Street 2:AP3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4318
Mailing Address - Country:US
Mailing Address - Phone:212-787-4119
Mailing Address - Fax:
Practice Address - Street 1:681 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2125
Practice Address - Country:US
Practice Address - Phone:718-221-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine