Provider Demographics
NPI:1285932079
Name:VADDE, RAGHAVA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHAVA
Middle Name:REDDY
Last Name:VADDE
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 1:535 US HIGHWAY 41 BYP N
Mailing Address - Street 2:# 239
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-6040
Mailing Address - Country:US
Mailing Address - Phone:941-486-6927
Mailing Address - Fax:941-486-6931
Practice Address - Street 1:540 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2900
Practice Address - Country:US
Practice Address - Phone:941-486-6927
Practice Address - Fax:941-486-6931
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO LICENCE207R00000X
FLME110476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14J08OtherBCBS
FL14J08OtherBCBS