Basic Information
| Provider Information | |||||||||
| NPI: | 1891747796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORA | ||||||||
| FirstName: | RAQUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 519 E ALLENS LN | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191191106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157531122 | ||||||||
| FaxNumber: | 2157531379 | ||||||||
| Practice Location | |||||||||
| Address1: | ERIE AVE AT FRONT STREET | ||||||||
| Address2: | ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 06/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | MD073122L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine | 207P00000X | MD073122L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25MA08379600 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PP0204X | 25MA08379600 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0018568280005 | 05 | PA | MEDICAID |