Provider Demographics
NPI:1972531275
Name:ALENCAR, RAQUEL OLIVA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:OLIVA
Last Name:ALENCAR
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:RAQUEL
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL, DEPARTMENT OF RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6304
Mailing Address - Fax:617-732-6317
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL - DEPARTMENT OF RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6304
Practice Address - Fax:617-732-6317
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2234042085R0202X
MA2305382085B0100X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000092601Medicare PIN