Provider Demographics
NPI:1871857391
Name:VADDEPALLY, RAJU KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:RAJU
Middle Name:KUMAR
Last Name:VADDEPALLY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:3530 KRAFT RD STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5020
Practice Address - Country:US
Practice Address - Phone:239-353-6636
Practice Address - Fax:239-354-1865
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164469207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120011100Medicaid