Active NPI
Russell C. Raphaely, MD
- Pediatric Anesthesiology Physician
- Wilmington, DE
National Provider Identifier
1609968452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Anesthesiology Physician
- License
- C10005241
- Practice address
- A.I. Dupont Hospital for Children
1600 Rockland Road
Wilmington, DE 19803-3607 - Phone
- (302) 651-4000
- Fax
- (302) 651-4945
- NPI assigned
- Sep 29, 2006
- Last updated
- Sep 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | C10005241 | DE | |
| Pediatric Anesthesiology Physician | 207LP3000X | C10005241 | DE | Primary |
| Pediatric Critical Care Medicine Physician | 2080P0203X | C10005241 | DE | |
| Anesthesiology Physician | 207L00000X | MA06427200 | NJ | |
| Anesthesiology Physician | 207L00000X | MD007844E | PA | |
| Pediatric Anesthesiology Physician | 207LP3000X | MA06427200 | NJ | |
| Pediatric Anesthesiology Physician | 207LP3000X | MD007844E | PA | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | MA06427200 | NJ | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | MD007844E | PA |
Addresses
Primary practice location
A.I. Dupont Hospital for Children
1600 Rockland Road
Wilmington, DE 19803-3607
Mailing address
Nemours Childrens Clinic
P.O. Box 404112
Atlanta, GA 30384-0001
Phone (904) 390-3610
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4399102 | Medicaid | MD | |
| 64572621 | Medicaid | KY | |
| 1569895 | Medicaid | LA | |
| 956134 | Medicaid | NY | |
| P8B187880 | Medicaid | TX | |
| 806298000 | Medicaid | ID | |
| 000684273 | Medicaid | PA | |
| 0224006 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10005241 | DE | MD | Pediatric Anesthesiology Physician |
| MA06427200 | NJ | MD | Pediatric Anesthesiology Physician |
| MD007844E | PA | MD | Pediatric Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221091200000",
"number": "1609968452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NEMOURS CHILDRENS CLINIC",
"address_2": "P.O. BOX 404112",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303840001",
"telephone_number": "904-390-3610",
"fax_number": "904-288-5890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "A.I. DUPONT HOSPITAL FOR CHILDREN",
"address_2": "1600 ROCKLAND ROAD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198033607",
"telephone_number": "302-651-4000",
"fax_number": "302-651-4945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAPHAELY",
"first_name": "RUSSELL",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2008-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "DE",
"license": "C10005241",
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "DE",
"license": "C10005241",
"primary": true
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "DE",
"license": "C10005241",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NJ",
"license": "MA06427200",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "PA",
"license": "MD007844E",
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "NJ",
"license": "MA06427200",
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "PA",
"license": "MD007844E",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "NJ",
"license": "MA06427200",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "PA",
"license": "MD007844E",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4399102",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64572621",
"state": "KY"
},
{
"code": "05",
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"issuer": null,
"identifier": "1569895",
"state": "LA"
},
{
"code": "05",
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"issuer": null,
"identifier": "956134",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P8B187880",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806298000",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000684273",
"state": "PA"
},
{
"code": "05",
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"issuer": null,
"identifier": "0224006",
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],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.