Provider Demographics
NPI:1245221274
Name:RAIKEN, DEBORAH F (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:F
Last Name:RAIKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1110
Mailing Address - Country:US
Mailing Address - Phone:716-332-4472
Mailing Address - Fax:716-332-4675
Practice Address - Street 1:560 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1110
Practice Address - Country:US
Practice Address - Phone:716-332-4472
Practice Address - Fax:716-332-4675
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144081DLOtherPREFERRED CARE
NY00764392Medicaid
NY040426002526OtherFIDELIS
NY00010143303OtherUNIVERA
NY000508658007OtherBC/BS
NY1209806OtherIHA
NY040426002526OtherFIDELIS
NY1209806OtherIHA