Provider Demographics
NPI:1982695540
Name:BUENO, RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:BUENO
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 1:39 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6715
Mailing Address - Country:US
Mailing Address - Phone:617-739-6554
Mailing Address - Fax:617-582-6171
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:CA 273
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8148
Practice Address - Fax:617-582-6171
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58728208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3030393Medicaid
MAJ07074Medicare ID - Type UnspecifiedMEDICARE
MAA66546Medicare UPIN