Provider Demographics
NPI:1942291158
Name:FARRA, RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:
Last Name:FARRA
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 1:300 KEARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-1816
Mailing Address - Country:US
Mailing Address - Phone:603-623-3013
Mailing Address - Fax:603-627-0620
Practice Address - Street 1:300 KEARNEY CIR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-1816
Practice Address - Country:US
Practice Address - Phone:603-623-3013
Practice Address - Fax:603-627-0620
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7079207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000355Medicaid
NHD03424Medicare UPIN
NHNH1084Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER