Healthcare Provider Details

I. General information

NPI: 1457618548
Provider Name (Legal Business Name): VIJAY KUDITHIPUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E TOWN ST STE 1200
COLUMBUS OH
43215-4601
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9506
  • Fax: 614-566-8224
Mailing address:
  • Phone: 614-788-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.131074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: