Provider Demographics
NPI:1407805542
Name:ACHECAR, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:ACHECAR
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 1:2405 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6214
Mailing Address - Country:US
Mailing Address - Phone:315-798-9788
Mailing Address - Fax:315-798-9766
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-798-9788
Practice Address - Fax:315-798-9766
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038829L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2949508Medicaid
NY00931237Medicaid
NY11826747OtherCAQH
NY6013043OtherMVP
PA000952420001Medicaid
PA050015064OtherRR MEDICARE
NY80514000041OtherFIDELIS
NY54602AMedicare PIN
NYRB7454Medicare PIN
NY2949508Medicaid
PA000952420001Medicaid