Provider Demographics
NPI:1144316175
Name:RAPHAEL, RALPH D (PHD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:D
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-825-0042
Mailing Address - Fax:410-825-0310
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-825-0042
Practice Address - Fax:410-825-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRO9214Medicare UPIN
MDG754Medicare ID - Type Unspecified