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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

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