Provider Demographics
NPI:1386637742
Name:SAINT RAPHAEL MR CENTER
Entity Type:Organization
Organization Name:SAINT RAPHAEL MR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENON
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTOPAPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-789-4120
Mailing Address - Street 1:11 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2320
Mailing Address - Country:US
Mailing Address - Phone:203-298-9113
Mailing Address - Fax:203-298-9106
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-4120
Practice Address - Fax:203-789-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004088896Medicaid
CTC00492Medicare ID - Type Unspecified