Provider Demographics
NPI:1477599702
Name:RAPHAEL, STEPHEN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRENDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1603
Mailing Address - Country:US
Mailing Address - Phone:856-874-0202
Mailing Address - Fax:856-874-0220
Practice Address - Street 1:3 BRENDENWOOD DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1603
Practice Address - Country:US
Practice Address - Phone:856-874-0202
Practice Address - Fax:856-874-0220
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2198304NJMedicaid
NJC53697Medicare UPIN
NJ073144Medicare ID - Type Unspecified