Provider Demographics
NPI:1548289762
Name:TAPIA, RAQUEL (MD)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:TAPIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:TAPIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2369842080P0210X
DEC100084662080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138541Medicaid
NY02671745Medicaid
PA102030235Medicaid
MD413467200Medicaid
MD413467200Medicaid
NY02671745Medicaid