Individual
ADITYA PANDU SUNIDJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1304 FAWCETT AVE, SUITE 100, TACOMA, WA 98402-1911
(253) 761-4200
(253) 383-3553
Mailing address
PO BOX 1535, TACOMA, WA 98401-1535
(253) 761-4200
(253) 383-3553
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
235938
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD60082442
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0252135
LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA
05
—
2001567
—
WA
01
—
G8882744
PTAN-TRA PIERCE CO
WA
01
—
G8882901
PTAN-UAOM
WA
01
—
G8883121
PTAN-MIO1
WA
01
—
G8883319
PTAN-TRA KING CO
WA
01
—
R174972
PTAN-PENDLETON, OREGON
WA
Enumeration date
02/05/2009
Last updated
09/03/2024
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