Provider Demographics
NPI:1710011861
Name:MARC I RAPHAELSON MD PA
Entity Type:Organization
Organization Name:MARC I RAPHAELSON MD PA
Other - Org Name:GREATER WASHINGTON SLEEP DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:I
Authorized Official - Last Name:RAPHAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-771-0274
Mailing Address - Street 1:525K EAST MARKET ST
Mailing Address - Street 2:BOX 326
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-771-0274
Mailing Address - Fax:703-771-0276
Practice Address - Street 1:525K EAST MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-771-0274
Practice Address - Fax:703-771-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710011861Medicaid
VA00X434M01Medicare Oscar/Certification
MD446M643FMedicare Oscar/Certification
DCG01339M01Medicare Oscar/Certification