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General NPI Number Information
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NPI Number | 1467677435
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Entity Type | Organization
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Legal Business Name | R. VEDALA AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1206 E NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2718
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Country | US
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Telephone | 812-234-8261
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Fax | 812-234-8262
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Provider Business Mailing Address
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Address Line | 2901 OHIO BLVD SUITE 127
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City | TERRE HAUTE
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State | IN
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Zip | 47803-2239
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Country | US
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Telephone | 812-234-8261
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Fax | 812-234-8262
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Authorized Official
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Title or Position | OWNER
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Name | RANGANANTH VEDALA
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Credential | MD
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Telephone | 812-235-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01027928
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License Number State | IN
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