Provider Demographics
NPI:1174804348
Name:RAPHA MEDICAL CLINIC PC
Entity type:Organization
Organization Name:RAPHA MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEDIJI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSINLOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-504-1211
Mailing Address - Street 1:10922 S TRYON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4151
Mailing Address - Country:US
Mailing Address - Phone:980-321-5231
Mailing Address - Fax:980-231-5238
Practice Address - Street 1:10922 S TRYON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4151
Practice Address - Country:US
Practice Address - Phone:980-321-5231
Practice Address - Fax:980-321-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty