Provider Demographics
NPI:1578562054
Name:RAPHAEL, HONG T-L (MD)
Entity Type:Individual
Prefix:MRS
First Name:HONG
Middle Name:T-L
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Mailing Address - Street 2:ST. MARY'S HOSPITAL @ AMSTERDAM
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:380 GUY PARK AVE
Practice Address - Street 2:ST. MARY'S HOSPITAL, FAM HLTH CNTR @ CARONDELET PAVILIO
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1055
Practice Address - Country:US
Practice Address - Phone:518-841-7415
Practice Address - Fax:518-841-7422
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183386-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01610457Medicaid
NY10002696OtherCDPHP
NY8234OtherMVP
NYI70033Medicare ID - Type Unspecified
NY01610457Medicaid