Provider Demographics
NPI:1295705911
Name:MEGERIAN, RAFFI G (MD)
Entity type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:G
Last Name:MEGERIAN
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 1:10000 SHANNONDELL DR.
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5615
Mailing Address - Country:US
Mailing Address - Phone:610-728-5241
Mailing Address - Fax:610-728-5322
Practice Address - Street 1:10000 SHANNONDELL DR.
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5615
Practice Address - Country:US
Practice Address - Phone:610-728-5241
Practice Address - Fax:610-728-5322
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421091207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
I10639Medicare UPIN
I10639Medicare UPIN
PA081000HK1Medicare PIN