Provider Demographics
NPI:1710246137
Name:BEZERRA, RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:BEZERRA
Suffix:
Gender:F
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:PRAIA DE BOTAFOGO 130
Mailing Address - Street 2:701
Mailing Address - City:RIO DE JANEIRO
Mailing Address - State:RIO DE JANEIRO
Mailing Address - Zip Code:22250040
Mailing Address - Country:BR
Mailing Address - Phone:617-899-7476
Mailing Address - Fax:
Practice Address - Street 1:PRAIA DE BOTAFOGO 130
Practice Address - Street 2:701
Practice Address - City:RIO DE JANEIRO
Practice Address - State:RIO DE JANEIRO
Practice Address - Zip Code:22250040
Practice Address - Country:BR
Practice Address - Phone:617-899-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMTL0001402085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology