Provider Demographics
NPI:1972570232
Name:PALADUGU, RAJA RAJESWARA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:RAJESWARA RAO
Last Name:PALADUGU
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-651-8100
Mailing Address - Fax:336-716-0030
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-651-8100
Practice Address - Fax:336-716-0030
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19254207R00000X, 208M00000X
NC200300274208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDQ5333OtherRAILROAD MEDICARE
SCT32550Medicaid
SCGP4690Medicaid
SC1316155112OtherGROUP NPI
SCGP5407Medicaid
SC110150751OtherRAILROAD MEDICARE
SCP00437298OtherRAILROAD MEDICARE
SC1578880043OtherGROUP NPI
SCP00437298OtherRAILROAD MEDICARE
SC1578880043OtherGROUP NPI
SCG225418784Medicare UPIN
SCGP5407Medicaid
SCG225418688Medicare PIN
SCT32550Medicaid
SC110150751Medicare PIN