Individual
MR. RAPHAEL T TSHIBANGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
990 SOUTH AVENUE, SUITE 104, ROCHESTER, NY 14620
(585) 256-3000
(585) 256-3045
Mailing address
990 SOUTH AVENUE, SUITE 104, ROCHESTER, NY 14620
(585) 256-3000
(585) 256-3045
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1395531
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00927591
—
NY
01
—
100876CK
PREFERRED CARE
NY
01
—
10511426
CAQH
—
01
—
2918
BLUE SHIELD
NY
01
—
4345433
AETNA
—
Enumeration date
03/09/2006
Last updated
07/08/2007
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