Provider Demographics
NPI:1790871846
Name:RAPHAEL, SAMI A (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:A
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 1:1329 PINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-282-2388
Mailing Address - Fax:716-282-0036
Practice Address - Street 1:1329 PINE AVENUE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-282-2388
Practice Address - Fax:716-282-0036
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197756208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010144401OtherUNIVERA
NY000523508001OtherBCBS
4668201OtherAETNA
6008322OtherGHI
NY01541620Medicaid
040426003495OtherFIDELIS
NY6407333OtherIHA
NY010065541OtherRAILROAD MEDICARE
NY1977560OtherWORKERS COMP
6008322OtherGHI
NY000523508001OtherBCBS