Provider Demographics
NPI:1972702884
Name:GARY ELLIOT RAFFEL D.O., F.A.C.P.
Entity Type:Organization
Organization Name:GARY ELLIOT RAFFEL D.O., F.A.C.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:RAFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-570-9700
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE 202A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-530-1150
Practice Address - Fax:301-260-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0045839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396747432OtherNATIONAL PROVIDER IDENTIF
MD5998787400Medicaid
450549Medicare PIN
MD5998787400Medicaid