Provider Demographics
NPI:1447345673
Name:RAFALOWSKI, ALICJA ELZBIETA (MD)
Entity type:Individual
Prefix:
First Name:ALICJA
Middle Name:ELZBIETA
Last Name:RAFALOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NORTH KERR AVENUE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3499
Mailing Address - Country:US
Mailing Address - Phone:910-395-0208
Mailing Address - Fax:910-395-0460
Practice Address - Street 1:108 NORTH KERR AVENUE
Practice Address - Street 2:SUITE E1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3499
Practice Address - Country:US
Practice Address - Phone:910-395-0208
Practice Address - Fax:910-395-0460
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891054MMedicaid
NC891054MMedicaid
G50608Medicare UPIN