Provider Demographics
NPI:1285802694
Name:RUDRARAJU, PRAVEEN (MD)
Entity type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:
Last Name:RUDRARAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EAST MAIN STREET - NORTHERN WESTCHESTER HOSPITAL
Mailing Address - Street 2:MEDICAL AFFAIRS OFFICE
Mailing Address - City:MT. KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-666-1200
Mailing Address - Fax:914-666-1965
Practice Address - Street 1:400 EAST MAIN STREET
Practice Address - Street 2:NORTHERN WESTCHESTER HOSPITAL, CRITICAL CARE
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1200
Practice Address - Fax:914-666-1978
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY247554207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease