Provider Demographics
NPI:1366715633
Name:LIPORACI LUCENA, RAFAEL ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ENRIQUE
Last Name:LIPORACI LUCENA
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 1:3 REGENCY PLZ
Mailing Address - Street 2:APT 709E
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3161
Mailing Address - Country:US
Mailing Address - Phone:917-297-0916
Mailing Address - Fax:
Practice Address - Street 1:174 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3280
Practice Address - Country:US
Practice Address - Phone:401-723-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine