Provider Demographics
NPI:1508846668
Name:PEDDADA, ANUJ V (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:V
Last Name:PEDDADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1425 N UNION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2871
Mailing Address - Country:US
Mailing Address - Phone:719-570-7675
Mailing Address - Fax:719-471-9314
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6831
Practice Address - Country:US
Practice Address - Phone:719-776-5281
Practice Address - Fax:719-471-9314
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-01-06
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Provider Licenses
StateLicense IDTaxonomies
HIMD231232085R0001X
CO381302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF12483Medicare UPIN