Provider Demographics
NPI:1356910194
Name:RAPHA MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:RAPHA MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNGHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-991-2500
Mailing Address - Street 1:14631 LEE HWY STE 311
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5834
Mailing Address - Country:US
Mailing Address - Phone:703-991-2500
Mailing Address - Fax:571-992-1500
Practice Address - Street 1:14631 LEE HWY STE 311
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5834
Practice Address - Country:US
Practice Address - Phone:703-991-2500
Practice Address - Fax:571-992-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty