Individual
BRIAN RAPHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5823 WIDEWATERS PKWY, SUITE 4, EAST SYRACUSE, NY 13057-3084
(315) 500-7546
Mailing address
5823 WIDEWATERS PKWY, SUITE 4, EAST SYRACUSE, NY 13057-3084
(315) 500-7546
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
262904
MA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
282257-1
NY
207R00000X
Internal Medicine Physician
MT199988
PA
Other
Enumeration date
06/16/2011
Last updated
11/10/2016
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