Provider Demographics
NPI:1487685632
Name:CONVIT, RAFAEL J (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:J
Last Name:CONVIT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-882-5799
Mailing Address - Fax:202-882-2112
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 4000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-882-5799
Practice Address - Fax:202-882-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD16621208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0916OtherBLUECROSS BLUESHIELD
DC0916OtherBLUECROSS BLUESHIELD
DC539941Medicare ID - Type Unspecified