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General NPI Number Information
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NPI Number | 1952667974
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Entity Type | Individual
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Provider Name | RAJ PENUMETSA MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1225 NE 2ND AVE
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City | PORTLAND
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State | OR
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Zip | 97232-2003
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Country | US
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Telephone | 503-944-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 PICKLE RD APT 11
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City | OREGON
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State | OH
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Zip | 43616-3935
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Country | US
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Telephone | 567-277-0342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | U9769
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.126661
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD220293
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License Number State | OR
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