Basic Information
| Provider Information | |||||||||
| NPI: | 1245231331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WURAPA | ||||||||
| FirstName: | EYAKO | ||||||||
| MiddleName: | KOFI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 COX RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230609263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049685700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21044 FREDERICK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208764132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402385432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 12/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/24/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200200189 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0076100 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136RG | 01 | NC | BCBS OF NC GROUP # 0169P | OTHER | 203204 | 01 | NC | MEDCOST | OTHER | 197700 | 01 | NC | MEDCOST | OTHER | 89136RG | 05 | NC | MEDICAID |