Provider Demographics
NPI:1326190208
Name:TORRACO, RALPH JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOHN
Last Name:TORRACO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLEANDER DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6805
Mailing Address - Country:US
Mailing Address - Phone:910-392-5889
Mailing Address - Fax:910-392-6869
Practice Address - Street 1:4000 OLEANDER DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6846
Practice Address - Country:US
Practice Address - Phone:910-392-5889
Practice Address - Fax:910-392-6869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000543Medicaid
NC2822169Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER