Provider Demographics
NPI:1962795336
Name:VEGA, RAFAEL A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 FRANCIS ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-634-7246
Mailing Address - Fax:617-632-0949
Practice Address - Street 1:110 FRANCIS ST STE 3B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-634-7246
Practice Address - Fax:617-634-0949
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101253072207T00000X
TXR6306207T00000X
MA278233207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery