Provider Demographics
NPI:1508915729
Name:RAPHAEL FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:RAPHAEL FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUMMANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-673-0738
Mailing Address - Street 1:3025 JACKS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2549
Mailing Address - Country:US
Mailing Address - Phone:412-673-0738
Mailing Address - Fax:412-673-0739
Practice Address - Street 1:3025 JACKS RUN RD
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-2549
Practice Address - Country:US
Practice Address - Phone:412-673-0738
Practice Address - Fax:412-673-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032205E261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01716747Medicaid
PA022017Medicare ID - Type Unspecified
PA01716747Medicaid