Provider Demographics
NPI:1710989405
Name:RAPHAEL, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 2ND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3625
Mailing Address - Country:US
Mailing Address - Phone:610-409-8830
Mailing Address - Fax:
Practice Address - Street 1:409 2ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3625
Practice Address - Country:US
Practice Address - Phone:610-409-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04068142207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048146000OtherIBC PROVIDER ID
PA087602OtherHIGHMARK BC PROVIDER ID
PAB35373Medicare UPIN