Provider Demographics
NPI:1114243516
Name:DUDDA SUBRAMANYA, RAGHUNANDAN (MD, FACC, FASNC)
Entity Type:Individual
Prefix:
First Name:RAGHUNANDAN
Middle Name:
Last Name:DUDDA SUBRAMANYA
Suffix:
Gender:M
Credentials:MD, FACC, FASNC
Other - Prefix:
Other - First Name:RAGHU
Other - Middle Name:
Other - Last Name:DUDDA SUBRAMANYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACC, FASNC
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:2309 E EVESHAM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1559
Practice Address - Country:US
Practice Address - Phone:856-325-5400
Practice Address - Fax:856-325-5416
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430083207RC0000X
NJ25MA08698900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease