Healthcare Provider Details

I. General information

NPI: 1730471764
Provider Name (Legal Business Name): RAPHAEL LOUIE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARSHALL ST
RICHMOND VA
23298-5028
US

IV. Provider business mailing address

PO BOX 980011
RICHMOND VA
23298-0011
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-2322
  • Fax:
Mailing address:
  • Phone: 804-628-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101270617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: