Provider Demographics
NPI:1477737021
Name:DAVID, RACQUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RACQUEL
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:MIDDLESEX HOSPITAL DBA MIDDLESEX HOSPITAL PHYSICIAN SER
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4720
Mailing Address - Fax:860-358-6271
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:MIDDLESEX HOSPITAL DBA MIDDLESEX HOSPITAL PHYSICIAN SER
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-4720
Practice Address - Fax:860-358-6271
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046061207R00000X, 207RH0002X
CTCT 046061208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT046061OtherCT LICENSE