Healthcare Provider Details

I. General information

NPI: 1841185857
Provider Name (Legal Business Name): RAPHA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY STE 100&110
CHARLOTTESVILLE VA
22911-8835
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY STE 100
CHARLOTTESVILLE VA
22911-8835
US

V. Phone/Fax

Practice location:
  • Phone: 434-249-9752
  • Fax:
Mailing address:
  • Phone: 434-249-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TILAHUN MEKONNEN GOSHU
Title or Position: CEO
Credential: DNP/PHD
Phone: 434-249-9752