| Rapha Medical Group, Llc | |
|
14631 Lee Hwy Ste 311 Centreville VA 20121-5834 | |
| (703) 991-2500 | |
| (571) 992-1500 |
| Full Name | Rapha Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 14631 Lee Hwy Ste 311, Centreville, Virginia |
| Authorized Official Name and Position | Junghee Shu (CEO) |
| Authorized Official Contact | 7039912500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rapha Medical Group, Llc 14631 Lee Hwy Ste 311 Centreville VA 20121-5834 Ph: (703) 991-2500 | Rapha Medical Group, Llc 14631 Lee Hwy Ste 311 Centreville VA 20121-5834 Ph: (703) 991-2500 |
| NPI Number | 1356910194 |
|---|---|
| Provider Enumeration Date | 06/24/2021 |
| Last Update Date | 11/23/2022 |
| Medicare PECOS PAC ID | 6800277443 |
|---|---|
| Medicare Enrollment ID | O20220714000157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356910194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Manolisa T Cornel-manaloto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679533327 PECOS PAC ID: 4385693209 Enrollment ID: I20220714000293 |
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