=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184518904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPHA MEDICAL PSYCH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 PETER JEFFERSON PKWY STE 110
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911-8835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-249-9752
-----------------------------------------------------
Fax | 803-650-3964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 179 LONDON CT
-----------------------------------------------------
City | RUCKERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22968-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-249-9752
-----------------------------------------------------
Fax | 803-650-3964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TILAHUN GOSHU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-249-9752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------