Provider Demographics
NPI:1780766790
Name:RAFFERTY, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ RM 502
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2506
Practice Address - Fax:856-968-8312
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67974207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1077341OtherHORIZON NJ HEALTH
2018037OtherUNITED HEALTHCARE
0758987000OtherAMERIHEALTH HMO, KEYSTONE, IBC
XK5413OtherHEALTHNET
148038OtherAMERIHEALTH PPO
24975OtherUNIVERSITY HEALTHPLAN
NJ7805802Medicaid
P1003002OtherOXFORD
010003895OtherAMERICHOICE
0758987000OtherAMERIHEALTH HMO, KEYSTONE, IBC
NJG83750Medicare UPIN