Provider Demographics
NPI:1770580094
Name:KOFAHI, RAID MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:RAID
Middle Name:MOHAMMED
Last Name:KOFAHI
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 1:1074 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6925
Mailing Address - Country:US
Mailing Address - Phone:302-422-0800
Mailing Address - Fax:302-346-2484
Practice Address - Street 1:111 NEUROLOGY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5368
Practice Address - Country:US
Practice Address - Phone:302-422-0800
Practice Address - Fax:302-346-2484
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100073152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034523Medicaid
DEI21424Medicare UPIN
DE015326C08Medicare PIN