Provider Demographics
NPI:1487755963
Name:RAFAL, KEITH WL (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WL
Last Name:RAFAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EDDIE DOWLING HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7327
Mailing Address - Country:US
Mailing Address - Phone:401-766-0800
Mailing Address - Fax:401-765-5904
Practice Address - Street 1:116 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7327
Practice Address - Country:US
Practice Address - Phone:401-766-0800
Practice Address - Fax:401-765-5904
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06749208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI23-00181OtherMEDICARE COMPLETE
MA404632OtherTUFTS
RI7680569OtherCOMMERCIAL
RI80579OtherRI HARVARD PILGRIM
MA22534OtherHARVARD PILGRIM
RI405187OtherBLUE CHIP
RI22166OtherBLUE CROSS OF RI
RI8725377002OtherRI CIGNA
RI4197OtherNEIGHBORHOOD HEALTH PLAN
MAJ06887OtherMASS BLUE CROSS
RI2567536OtherAETNA
RI23-00080OtherUNITED HEALTH
MA3020185OtherMASS HEALTH
RI80579OtherRI HARVARD PILGRIM
RIA59218Medicare UPIN