Healthcare Provider Details

I. General information

NPI: 1407481732
Provider Name (Legal Business Name): RAPHA HEALTHCARE SERVICES - LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 BEN FRANKLIN BLVD
DURHAM NC
27704-2147
US

IV. Provider business mailing address

4411 BEN FRANKLIN BLVD
DURHAM NC
27704-2147
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-5474
  • Fax:
Mailing address:
  • Phone: 919-471-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON HALLIDAY
Title or Position: MANAGING MEMBER
Credential:
Phone: 919-471-5474