Healthcare Provider Details

I. General information

NPI: 1568991297
Provider Name (Legal Business Name): ADITYA ETURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE BLDG N
WEST READING PA
19611-2143
US

IV. Provider business mailing address

834 CHESTNUT ST STE 308
PHILADELPHIA PA
19107-5127
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-0900
  • Fax:
Mailing address:
  • Phone: 215-503-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMT222567
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD478749
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD17002
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03927
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: