Provider Demographics
NPI:1700994837
Name:RAPHAEL HEART GROUP. P.C.
Entity Type:Organization
Organization Name:RAPHAEL HEART GROUP. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUN-TAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-586-3982
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0430
Mailing Address - Country:US
Mailing Address - Phone:570-586-3982
Mailing Address - Fax:570-585-2896
Practice Address - Street 1:105 LAYTON ROAD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18511
Practice Address - Country:US
Practice Address - Phone:570-586-3982
Practice Address - Fax:570-585-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA701149Medicare ID - Type Unspecified