Provider Demographics
NPI:1831400399
Name:MARK, RAPHAEL (MD)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:MARK
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 1:386 YONGE ST
Mailing Address - Street 2:APT 4811
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M5B 0A5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 YONGE ST
Practice Address - Street 2:APT 4811
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M5B 0A5
Practice Address - Country:CA
Practice Address - Phone:168-584-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273183207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology