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NPI Code Detail

MEDICARE: DR. RAJA KUMARI VAIDADI M.D

MEDICARE: DR. RAJA KUMARI VAIDADI 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
1207Q00000XFamily Medicine Physician125061196IL

General Provider Information

NPI Number : 1588918395
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAJA KUMARI VAIDADI M.D
Provider Business Mailing Address
First Line : 102 WOODMONT BLVD STE 600
Second Line :
City : NASHVILLE
State : TN
Zip : 37205-5250
Country : US
Telephone Number : 888-987-1151
Fax Number :
Provider Business Practice Location Address
First Line : 3022 EASTWAY DR STE 1-3
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5642
Country : US
Telephone Number : 704-251-8228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2012
Last Update Date : 08/05/2024

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