Provider Demographics
NPI:1245231331
Name:WURAPA, EYAKO KOFI (MD)
Entity Type:Individual
Prefix:
First Name:EYAKO
Middle Name:KOFI
Last Name:WURAPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:21044 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4132
Practice Address - Country:US
Practice Address - Phone:240-238-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200189207Q00000X
MDD0076100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136RGOtherBCBS OF NC GROUP # 0169P
NC203204OtherMEDCOST
NC197700OtherMEDCOST
NC89136RGMedicaid
NC203204OtherMEDCOST
NC2001175DMedicare PIN
NC136RGOtherBCBS OF NC GROUP # 0169P
NC197700OtherMEDCOST