Provider Demographics
NPI:1396747432
Name:RAFFEL, GARY E (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:RAFFEL
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 1:16529 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3696
Mailing Address - Country:US
Mailing Address - Phone:302-684-2000
Mailing Address - Fax:302-644-6860
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3696
Practice Address - Country:US
Practice Address - Phone:302-684-2000
Practice Address - Fax:302-644-6860
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:2006-04-05
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
DEC2-0011017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD450549Medicare ID - Type Unspecified
MDF88459Medicare UPIN
MD598781400Medicaid