Provider Demographics
NPI:1780642892
Name:RAABE, DANIEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:RAABE
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 1:115 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8423
Mailing Address - Country:US
Mailing Address - Phone:802-382-3443
Mailing Address - Fax:802-388-5614
Practice Address - Street 1:115 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8423
Practice Address - Country:US
Practice Address - Phone:802-382-3443
Practice Address - Fax:802-388-5614
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005592174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004855Medicaid
NY00662597Medicaid
VT060026218OtherRR MEDICARE
VT0004855Medicaid
VTVT4855Medicare ID - Type Unspecified