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General NPI Number Information
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NPI Number | 1871925099
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Entity Type | Organization
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Legal Business Name | RAPHAEL D LANADE, MD PLLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 6106 SHALLOWFORD RD SUITE100
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2239
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Country | US
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Telephone | 423-208-9377
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Fax | 423-475-5143
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Provider Business Mailing Address
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Address Line | 6106 SHALLOWFORD RD SUITE100
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2239
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Country | US
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Telephone | 423-208-9377
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Fax | 423-475-5143
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAPHAEL DADA LANADE
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Credential | M.D
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Telephone | 423-208-9377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31717
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License Number State | TN
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