Healthcare Provider Details

I. General information

NPI: 1982750667
Provider Name (Legal Business Name): RAGINI KUDCHADKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE 2ND FLOOR
ATLANTA GA
30322-1443
US

IV. Provider business mailing address

1365 CLIFTON RD NE 2ND FLOOR
ATLANTA GA
30322-1443
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2407
  • Fax: 404-778-5961
Mailing address:
  • Phone: 404-778-2407
  • Fax: 404-778-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME104126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: