Provider Demographics
NPI:1437395266
Name:CIRES-DROUET, RAFAEL S (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:S
Last Name:CIRES-DROUET
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5349
Mailing Address - Fax:410-328-3929
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5349
Practice Address - Fax:410-328-3292
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0565207R00000X
MDD79988207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD857004300Medicaid
TX285022401Medicaid
MDS062-0589OtherCAREFIRST BC/BS
TXTXB137078Medicare Oscar/Certification