1124085246 NPI number — RAFEL TAPPOUNI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124085246 NPI number — RAFEL TAPPOUNI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAPPOUNI

Provider First Name:

RAFEL

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1124085246

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/08/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 198441

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30384-8441

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

813-745-7365

Provider Business Mailing Address Fax Number:

813-449-8618

Provider First Line Business Practice Location Address:

1796 RIDGE OAKS DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OAK RIDGE

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27310-8714

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

813-745-7365

Provider Business Practice Location Address Fax Number:

813-449-8618

Provider Enumeration Date:

05/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  MD427572 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 2012-00166 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: ME129700 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: Q0016Q . This is a "SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 1124085246 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1124085246 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 7985796 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1124085246 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 2603716 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 276988 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 185FN . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: P01333821 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".