Provider Demographics
NPI:1972683001
Name:RAAB, GARY W (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:RAAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3826
Mailing Address - Country:US
Mailing Address - Phone:609-399-1862
Mailing Address - Fax:609-399-1572
Practice Address - Street 1:500 E 6TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3826
Practice Address - Country:US
Practice Address - Phone:609-399-1862
Practice Address - Fax:609-399-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB048583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1837401Medicaid
NJ1837401Medicaid
NJ762101Medicare ID - Type Unspecified