Organization Name:  SAINT RAPHAEL FACULTY PHYSICIANS


Practice Location:
1450 CHAPEL ST  NEW HAVEN, CT 06511 US
Tel: 203-789-5946  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	2084P0800X	Physicians Psychiatry & Neurology Psychiatry
N	1223S0112X	Dental Providers Dentist
N	363A00000X	Physician Assistants & Advanced Practice Nursing Providers Physician Assistant
N	204E00000X	Physicians Oral & Maxillofacial Surgery
N	207RC0000X	Physicians Internal Medicine
N	207RG0100X	Physicians Internal Medicine
N	207RH0003X	Physicians Internal Medicine
N	207RI0200X	Physicians Internal Medicine
N	207RP1001X	Physicians Internal Medicine
N	207RR0500X	Physicians Internal Medicine
N	207V00000X	Physicians Obstetrics & Gynecology
N	207Y00000X	Physicians Otolaryngology
N	2080N0001X	Physicians Pediatrics
N	208600000X	Physicians Surgery
Y	207R00000X	Physicians Internal Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
	008002476	CT	05
	008003155	CT	05
	008002212	CT	05
	008002615	CT	05
	008002619	CT	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin