Provider Demographics
NPI:1568454064
Name:EDULA, RAJA GOPAL REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:RAJA GOPAL REDDY
Middle Name:
Last Name:EDULA
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 1:4011 TALBOT RD S STE 500
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5782
Mailing Address - Country:US
Mailing Address - Phone:425-690-3488
Mailing Address - Fax:425-690-9088
Practice Address - Street 1:4011 TALBOT RD S STE 500
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5782
Practice Address - Country:US
Practice Address - Phone:425-690-3488
Practice Address - Fax:425-690-9088
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60834483207R00000X, 207RG0100X
NJ25MA09332700207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2104972Medicaid
FL13247ZMedicare ID - Type Unspecified