Provider Demographics
NPI:1871925099
Name:RAPHAEL D LANADE, MD PLLC
Entity type:Organization
Organization Name:RAPHAEL D LANADE, MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:DADA
Authorized Official - Last Name:LANADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-208-9377
Mailing Address - Street 1:6106 SHALLOWFORD RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2239
Mailing Address - Country:US
Mailing Address - Phone:423-208-9377
Mailing Address - Fax:423-475-5143
Practice Address - Street 1:6106 SHALLOWFORD RD
Practice Address - Street 2:SUITE100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2239
Practice Address - Country:US
Practice Address - Phone:423-208-9377
Practice Address - Fax:423-475-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty