Provider Demographics
NPI:1861463739
Name:SEMIDEI, RAFAEL G SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:G
Last Name:SEMIDEI
Suffix:SR
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 1:7415 COULSON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24312-3361
Mailing Address - Country:US
Mailing Address - Phone:276-733-0637
Mailing Address - Fax:
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-9990
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001014942084P0005X
VA01012303962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51780Medicare UPIN