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NPI Code Detail

MEDICARE: VIDYA RAJU M.D.

MEDICARE: VIDYA RAJU 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
1208000000XPediatrics PhysicianMT188576PA
2208000000XPediatrics Physician244048MA
3207R00000XInternal Medicine Physician244048MA

General Provider Information

NPI Number : 1699898809
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIDYA RAJU M.D.
Provider Business Mailing Address
First Line : 1069 BROADWAY
Second Line :
City : SAUGUS
State : MA
Zip : 01906-3210
Country : US
Telephone Number : 781-233-1450
Fax Number :
Provider Business Practice Location Address
First Line : 1069 BROADWAY
Second Line :
City : SAUGUS
State : MA
Zip : 01906-3210
Country : US
Telephone Number : 781-233-1450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 01/30/2013

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