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General NPI Number Information
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NPI Number | 1174804348
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Entity Type | Organization
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Legal Business Name | RAPHA MEDICAL CLINIC PC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 10922 S TRYON ST SUITE A
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City | CHARLOTTE
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State | NC
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Zip | 28273-4151
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Country | US
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Telephone | 980-321-5231
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Fax | 980-321-5238
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Provider Business Mailing Address
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Address Line | 10922 S TRYON ST SUITE A
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City | CHARLOTTE
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State | NC
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Zip | 28273-4151
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Country | US
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Telephone | 980-321-5231
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Fax | 980-231-5238
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Authorized Official
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Title or Position | OWNER
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Name | ADEDIJI O OSINLOYE
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Credential |
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Telephone | 704-504-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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