Provider Demographics
NPI:1902896988
Name:EMPEDRAD, RAQUEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:B
Last Name:EMPEDRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAQUEL
Other - Middle Name:B
Other - Last Name:BALADAJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 N BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1554
Mailing Address - Country:US
Mailing Address - Phone:215-569-1111
Mailing Address - Fax:215-569-8797
Practice Address - Street 1:205 N BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1554
Practice Address - Country:US
Practice Address - Phone:215-569-1111
Practice Address - Fax:215-569-8797
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08062300207K00000X
PAMD428661207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104941G55Medicare PIN
NJ123181DSCMedicare PIN
H72154Medicare UPIN