Individual provider Active NPI

Brandon Raquet, DO

  • Student in an Organized Health Care Education/Training Program
  • Philadelphia, PA
National Provider Identifier
1629915723
Registry record updated Jun 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
OT025362 Issued in PA
Practice address
111 S 11TH St Ste 8290
Philadelphia, PA 19107-4870
Phone
(215) 955-2370
Fax
(215) 955-0677
NPI assigned
Apr 29, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OT025362 PA Primary

Addresses

Primary practice location

111 S 11TH St Ste 8290
Philadelphia, PA 19107-4870

Mailing address

111 S 11TH St Ste 8290
Philadelphia, PA 19107-4870
Phone (215) 955-2370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260626002228 PA Order and Referring Only - AnesthesiologyPractitioner - Anesthesiology 4981177383

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OT025362PAMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1777420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780790400000",
    "number": "1629915723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE 8290",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074870",
            "telephone_number": "215-955-2370",
            "fax_number": "215-955-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE 8290",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074870",
            "telephone_number": "215-955-2370",
            "fax_number": "215-955-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAQUET",
        "first_name": "BRANDON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-29",
        "last_updated": "2026-06-07",
        "certification_date": "2026-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT025362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.