Provider Demographics
NPI:1558517540
Name:KOPPALA, RAJAH VIKRAMADITYA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAH
Middle Name:VIKRAMADITYA
Last Name:KOPPALA
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:EMORY UNIVERSITY HOSPITAL
Mailing Address - Street 2:1364 CLIFTON ROAD
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30330-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL
Practice Address - Street 2:1364 CLIFTON ROAD
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30330-0001
Practice Address - Country:US
Practice Address - Phone:770-630-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0029302085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology