Provider Demographics
NPI:1700296225
Name:RIEVES, RAFEL DWAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFEL
Middle Name:DWAINE
Last Name:RIEVES
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 1:1907 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3309
Mailing Address - Country:US
Mailing Address - Phone:202-302-4197
Mailing Address - Fax:
Practice Address - Street 1:1907 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3309
Practice Address - Country:US
Practice Address - Phone:202-302-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD16216261QH0100X
MS08795261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service