Individual
DR. RAGHU MADDELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
1400 N RITTER AVE STE 479, INDIANAPOLIS, IN 46219-3050
(317) 355-1470
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01079040A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273892132
TAX ID
NJ
Enumeration date
07/25/2008
Last updated
11/27/2023
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