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Raphael Agada
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NPI Number Detailed Information
Provider Information:
| Name: | Raphael Agada |
| Gender: | M |
| Provider License Number If Given: | 101840585 |
NPI Information:
| NPI: | 1205835725 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 2/9/2009 |
Provider Business Mailing Address:
| Address: | 801 S ADAMS ST Petersburg, VA 23803 |
| Phone Number: | 8048625991 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 801 S ADAMS ST Petersburg, VA 23803 |
| Phone Number: | 8048625991 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 207R00000X |
| Secondary (if any): | |
| State: | VA |
