Provider Demographics
NPI:1336110345
Name:TOMAINE, RAQUEL M (DO)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:M
Last Name:TOMAINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RAQUEL
Other - Middle Name:M
Other - Last Name:SZLANIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:99 N WEST END BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1272
Practice Address - Country:US
Practice Address - Phone:215-538-0202
Practice Address - Fax:215-538-9580
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013283280003Medicaid
PA1013283280003Medicaid
PA093182Medicare PIN