Provider Demographics
NPI:1346276078
Name:CHOWDARY, RAJ PENUMARTHI (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:PENUMARTHI
Last Name:CHOWDARY
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 1:4115 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-9769
Mailing Address - Country:US
Mailing Address - Phone:610-248-5506
Mailing Address - Fax:610-432-4083
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6212
Practice Address - Country:US
Practice Address - Phone:610-434-1269
Practice Address - Fax:610-432-4083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033817E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37508Medicare UPIN
PA128660U3AMedicare ID - Type Unspecified