Provider Demographics
NPI:1275770950
Name:RAU, STEFAN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:THOMAS
Last Name:RAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HEALTHY WAY
Mailing Address - Street 2:ELLENVILLE REGIONAL HOSPITAL- RADIOLOGY DEPT
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5612
Mailing Address - Country:US
Mailing Address - Phone:267-257-9213
Mailing Address - Fax:
Practice Address - Street 1:10 HEALTHY WAY
Practice Address - Street 2:ELLENVILLE REGIONAL HOSPITAL- RADIOLOGY DEPT
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428
Practice Address - Country:US
Practice Address - Phone:845-647-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2576342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03249929Medicaid