Provider Demographics
NPI:1851326466
Name:BINIAURISHVILI, RAOUL G (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:RAOUL
Middle Name:G
Last Name:BINIAURISHVILI
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2322
Mailing Address - Country:US
Mailing Address - Phone:609-497-7576
Mailing Address - Fax:
Practice Address - Street 1:11685-C BUSTLETON AVE
Practice Address - Street 2:HENDRIX CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-464-7820
Practice Address - Fax:215-464-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048245L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014094500003Medicaid
F51469Medicare UPIN
PA733403Medicare PIN