Provider Demographics
NPI:1518142504
Name:SURYADEVARA, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SURYADEVARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 NE CORNELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5434
Mailing Address - Country:US
Mailing Address - Phone:503-597-3130
Mailing Address - Fax:503-597-3140
Practice Address - Street 1:6355 NE CORNELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5434
Practice Address - Country:US
Practice Address - Phone:503-597-3130
Practice Address - Fax:503-597-3140
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine