Healthcare Provider Details

I. General information

NPI: 1215182464
Provider Name (Legal Business Name): RAPHA MEDICAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MAIN ST
STANLEY NC
28164-2011
US

IV. Provider business mailing address

222 S MAIN ST
STANLEY NC
28164-2011
US

V. Phone/Fax

Practice location:
  • Phone: 704-263-4716
  • Fax: 704-263-8169
Mailing address:
  • Phone: 704-263-4716
  • Fax: 704-263-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number28091
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BETH S TARKINGTON
Title or Position: OWNER
Credential: M.D.
Phone: 704-263-4716