Individual
DR. MUDUNURI V RAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 FLEETWOOD DR, EASLEY, SC 29640
(864) 442-7200
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6174
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20898
SC
208M00000X
Hospitalist Physician
20898
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110200011
RAILROAD MEDICARE
SC
01
—
1124095484
NPI
SC
01
—
1316155112
GROUP NPI
SC
05
—
GP4690
—
SC
01
—
P00209467
RAILROAD MEDICARE
SC
01
—
P00437301
RAILROAD MEDICARE
SC
05
—
T48874
—
SC
Enumeration date
03/07/2006
Last updated
10/19/2018
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