MEDICARE: DR. RAJAH VIKRAMADITYA KOPPALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	002930	GA

General Provider Information

NPI Number	:	1558517540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJAH VIKRAMADITYA KOPPALA MD

Provider Business Mailing Address
First Line	:	EMORY UNIVERSITY HOSPITAL
Second Line	:	1364 CLIFTON ROAD
City	:	ATLANTA
State	:	GA
Zip	:	30330-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	EMORY UNIVERSITY HOSPITAL
Second Line	:	1364 CLIFTON ROAD
City	:	ATLANTA
State	:	GA
Zip	:	30330-0001
Country	:	US
Telephone Number	:	770-630-5154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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