Basic Information
| Provider Information | |||||||||
| NPI: | 1508846668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEDDADA | ||||||||
| FirstName: | ANUJ | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 N UNION BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809092871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707675 | ||||||||
| FaxNumber: | 7194719314 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 N NEVADA AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197765281 | ||||||||
| FaxNumber: | 7194719314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 38130 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.