Provider Demographics
NPI:1538142161
Name:DAVARO, RAUL E (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:E
Last Name:DAVARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:630 PLANTATION STREET WOT 12TH FL
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-3122
Mailing Address - Fax:508-368-3123
Practice Address - Street 1:123 SUMMER STREET SUITE 220 S
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2903
Practice Address - Country:US
Practice Address - Phone:508-368-3122
Practice Address - Fax:508-368-3123
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2022-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA79089207RI0200X
PAMD478859207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3172864Medicaid
MAG58805Medicare UPIN
MA3172864Medicaid