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NPI Code Detail

MEDICARE: DR. RAJA GOPAL REDDY EDULA M.D

MEDICARE: DR. RAJA GOPAL REDDY EDULA M.D
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
1207R00000XInternal Medicine PhysicianMD60834483WA
2207RI0008XHepatology Physician25MA09332700NJ
3207RG0100XGastroenterology PhysicianMD60834483WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568454064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAJA GOPAL REDDY EDULA M.D
Provider Business Mailing Address
First Line : 4011 TALBOT RD S STE 500
Second Line :
City : RENTON
State : WA
Zip : 98055-5782
Country : US
Telephone Number : 425-690-3488
Fax Number : 425-690-9088
Provider Business Practice Location Address
First Line : 4011 TALBOT RD S STE 500
Second Line :
City : RENTON
State : WA
Zip : 98055-5782
Country : US
Telephone Number : 425-690-3488
Fax Number : 425-690-9088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 02/23/2023

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