Provider Demographics
NPI:1982850525
Name:RICHARD A RAABE DPM INC
Entity Type:Organization
Organization Name:RICHARD A RAABE DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-477-6265
Mailing Address - Street 1:128 WERTZ AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4196
Mailing Address - Country:US
Mailing Address - Phone:330-477-6265
Mailing Address - Fax:330-477-6306
Practice Address - Street 1:128 WERTZ AVE NW STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-477-6265
Practice Address - Fax:330-477-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1714213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0281716Medicaid
OH0785960001OtherPTAN
RA0417934Medicare PIN
T80413Medicare UPIN