Provider Demographics
NPI:1316924707
Name:RAFFEL, COREY (MD, PHD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:RAFFEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY M780
Mailing Address - Street 2:505 PARNASSUS AVE.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-3489
Mailing Address - Fax:415-353-3907
Practice Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY M780
Practice Address - Street 2:505 PARNASSUS AVE.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-3489
Practice Address - Fax:415-353-3907
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46212207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137022700Medicaid
MNP00301381Medicare ID - Type UnspecifiedRAILROAD
MN137022700Medicaid
E96379Medicare UPIN