Provider Demographics
NPI:1336115443
Name:CHADALAVADA, RAJAGOPAL (MD)
Entity Type:Individual
Prefix:
First Name:RAJAGOPAL
Middle Name:
Last Name:CHADALAVADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 MONTGOMERY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4464
Mailing Address - Country:US
Mailing Address - Phone:513-794-5600
Mailing Address - Fax:513-281-1908
Practice Address - Street 1:10600 MONTGOMERY RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4464
Practice Address - Country:US
Practice Address - Phone:513-794-5600
Practice Address - Fax:513-281-1908
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084399207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000357785OtherANTHEM
OH000000357785OtherANTHEM