Provider Demographics
NPI:1194744870
Name:RAFFALLI, PETER C (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:RAFFALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 11
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6388
Mailing Address - Fax:617-730-0284
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6388
Practice Address - Fax:617-730-0284
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA806882084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110055834AMedicaid
MA110055834AMedicaid
MAJ3119201Medicare PIN