Healthcare Provider Details

I. General information

NPI: 1508846668
Provider Name (Legal Business Name): ANUJ V PEDDADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE SUITE 101
COLORADO SPRINGS CO
80907-6831
US

IV. Provider business mailing address

1425 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80909-2871
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5281
  • Fax: 719-471-9314
Mailing address:
  • Phone: 719-570-7675
  • Fax: 719-471-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD23123
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number38130
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: