Provider Demographics
NPI:1942298542
Name:RAIFE, THOMAS JAY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAY
Last Name:RAIFE
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 1:105 STANDISH CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5131
Mailing Address - Country:US
Mailing Address - Phone:319-541-5573
Mailing Address - Fax:
Practice Address - Street 1:105 STANDISH CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-5131
Practice Address - Country:US
Practice Address - Phone:319-541-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36858207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2114454Medicaid
IA40227OtherWELLMARK BCBS
IA33948OtherWELLMARK BCBS
IA1114454Medicaid
IAI9691Medicare PIN
IAP00050287Medicare PIN
F85807Medicare UPIN
IA2114454Medicaid