Provider Demographics
NPI:1427114735
Name:BUDHARAJU, VENKATA G (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:G
Last Name:BUDHARAJU
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 1:6229 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5025
Mailing Address - Country:US
Mailing Address - Phone:727-623-9913
Mailing Address - Fax:
Practice Address - Street 1:6229 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-623-9913
Practice Address - Fax:727-803-6852
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187682207R00000X
FLME108425207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01264969OtherRAILROAD MEDICARE
FL14C73OtherBCBS
FL003474700Medicaid
FLP01264969OtherRAILROAD MEDICARE