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NPI Code Detail

MEDICARE: RAPHAEL AGADA MD

MEDICARE: RAPHAEL AGADA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician0101840585VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21205835725OTHERVABCBS

General Provider Information

NPI Number : 1205835725
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAPHAEL AGADA MD
Provider Business Mailing Address
First Line : 801 S ADAMS ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-5149
Country : US
Telephone Number : 804-862-5991
Fax Number :
Provider Business Practice Location Address
First Line : 801 S ADAMS ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-5149
Country : US
Telephone Number : 804-862-5991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 02/09/2009

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