Provider Demographics
NPI:1538216320
Name:TOUMANOVA, RAISA (MD)
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:TOUMANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 OCEAN CT
Mailing Address - Street 2:APARTMENT 7-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6054
Mailing Address - Country:US
Mailing Address - Phone:718-382-7235
Mailing Address - Fax:718-382-0009
Practice Address - Street 1:1670 E 17TH ST
Practice Address - Street 2:SUITE 2B/2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1281
Practice Address - Country:US
Practice Address - Phone:718-676-1633
Practice Address - Fax:718-676-1635
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY225064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02398121Medicaid
NY02398121Medicaid
H85953Medicare UPIN