Provider Demographics
NPI:1528009461
Name:BARCIA, RAFAEL GUSTAVO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:GUSTAVO
Last Name:BARCIA
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 1:6200 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1409
Mailing Address - Country:US
Mailing Address - Phone:516-945-7150
Mailing Address - Fax:718-945-2596
Practice Address - Street 1:6200 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1409
Practice Address - Country:US
Practice Address - Phone:516-945-7150
Practice Address - Fax:718-945-2596
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335713Medicaid
NY00335713Medicaid
NYC11838Medicare UPIN