MEDICARE: DR. RAJASRI DHARANI PALEPU 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	208M00000X	Hospitalist Physician	MD60022490	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	MD60022490	WA

General Provider Information

NPI Number	:	1568644607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJASRI DHARANI PALEPU MD

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 HARBOUR POINTE BLVD SW
Second Line	:
City	:	MUKILTEO
State	:	WA
Zip	:	98275-5457
Country	:	US
Telephone Number	:	425-347-6330
Fax Number	:	425-374-6335

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

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	06/22/2021

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