Basic Information
| Provider Information | |||||||||
| NPI: | 1972570232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALADUGU | ||||||||
| FirstName: | RAJA | ||||||||
| MiddleName: | RAJESWARA RAO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3367160030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 W D ST | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3367160030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 19254 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 200300274 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1578880043 | 01 | SC | GROUP NPI | OTHER | DQ5333 | 01 | SC | RAILROAD MEDICARE | OTHER | 1316155112 | 01 | SC | GROUP NPI | OTHER | 110150751 | 01 | SC | RAILROAD MEDICARE | OTHER | T32550 | 05 | SC | MEDICAID | GP5407 | 05 | SC | MEDICAID | P00437298 | 01 | SC | RAILROAD MEDICARE | OTHER | GP4690 | 05 | SC | MEDICAID |