Provider Demographics
NPI:1275510695
Name:RAPHA HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:RAPHA HEALTH SYSTEM INC
Other - Org Name:RAPHA MEDICAL CLINIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MD
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 1:1905 SKIBO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-864-4357
Mailing Address - Fax:910-221-0099
Practice Address - Street 1:1905 SKIBO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1518
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:2005-12-28
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100099170100000X
207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129MGMedicaid
NC2331203Medicare PIN
NCH41880Medicare UPIN