Provider Demographics
NPI:1831217553
Name:BEAVER HEAD AND NECK SURGICAL ASSOCIATES, LTD.
Entity type:Organization
Organization Name:BEAVER HEAD AND NECK SURGICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RAFALKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-728-7800
Mailing Address - Street 1:1301 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-3116
Mailing Address - Country:US
Mailing Address - Phone:724-728-7800
Mailing Address - Fax:724-728-8115
Practice Address - Street 1:1301 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-3116
Practice Address - Country:US
Practice Address - Phone:724-728-7800
Practice Address - Fax:724-728-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016925E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty