Individual
BHAVANI PEDDAGOVINDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4572
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4572
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD158124
OR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD158124
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC GROUP NPI
OR
01
—
161133
NBMC GROUP MEDICAID
OR
05
—
500648004
—
OR
01
—
930635514
NBMC GROUP TAX ID FOR BILLING
OR
01
—
P01278284
RAILROAD MEDICARE
OR
01
—
R0000WFBTV
NBMC-GROUP MEDICARE
OR
Enumeration date
09/24/2008
Last updated
10/01/2014
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