Provider Demographics
NPI:1427081884
Name:LANADE, RAPHAEL DADA (MD)
Entity type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:DADA
Last Name:LANADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 100
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:SUITE 100
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH08174Medicare UPIN
TN44-44002Medicare ID - Type Unspecified
TN3282227Medicare ID - Type Unspecified
TN3859655Medicare ID - Type Unspecified