Healthcare Provider Details

I. General information

NPI: 1467415091
Provider Name (Legal Business Name): RAMESH K ADIRAJU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BATH RD
BRISTOL PA
19007-3101
US

IV. Provider business mailing address

501 BATH RD
BRISTOL PA
19007-3101
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-9578
  • Fax: 215-785-9579
Mailing address:
  • Phone: 215-785-9578
  • Fax: 215-785-9579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD041172L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD041172L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: