Provider Demographics
NPI:1932169588
Name:VAFAI, RADIANCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:RADIANCE
Middle Name:E
Last Name:VAFAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:346 WEST BUTLER STREET
Mailing Address - Street 2:LEXINGTON PEDIATRIC PRACTICE
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-359-8855
Mailing Address - Fax:803-359-1257
Practice Address - Street 1:346 WEST BUTLER STREET
Practice Address - Street 2:LEXINGTON PEDIATRIC PRACTICE
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-359-8855
Practice Address - Fax:803-359-1257
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC25532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC255324Medicaid