Provider Demographics
NPI:1861666034
Name:FOFARIA, RACHANA SURA (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:SURA
Last Name:FOFARIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2406 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6678
Mailing Address - Country:US
Mailing Address - Phone:919-786-5001
Mailing Address - Fax:919-786-5051
Practice Address - Street 1:2406 BLUE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6678
Practice Address - Country:US
Practice Address - Phone:919-786-5001
Practice Address - Fax:919-786-5051
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2014-07-22
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Provider Licenses
StateLicense IDTaxonomies
NC2011-01721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2011-01721OtherLICENSE NUMBER