Provider Demographics
NPI:1003874975
Name:RAPHA HEALTH SYSTEM
Entity Type:Organization
Organization Name:RAPHA HEALTH SYSTEM
Other - Org Name:RAPHA PRIMARY CARE CENTER OF FAYETTEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHIDI
Authorized Official - Last Name:UBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, INTERNAL MEDICIN
Authorized Official - Phone:910-864-4357
Mailing Address - Street 1:5085 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1523
Mailing Address - Country:US
Mailing Address - Phone:910-864-4357
Mailing Address - Fax:910-221-0099
Practice Address - Street 1:5085 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1523
Practice Address - Country:US
Practice Address - Phone:910-864-4357
Practice Address - Fax:910-221-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH41880Medicare UPIN