Provider Demographics
NPI:1629377346
Name:MAGAZANIK, RAISA D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAISA
Middle Name:D
Last Name:MAGAZANIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1801 WINCHESTER AVE APT B15
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4604
Mailing Address - Country:US
Mailing Address - Phone:215-464-3838
Mailing Address - Fax:215-464-3899
Practice Address - Street 1:1701 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3160
Practice Address - Country:US
Practice Address - Phone:215-464-3838
Practice Address - Fax:215-464-3899
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health