Provider Demographics
NPI:1588611347
Name:CHEPURI, VINAYA B (MD)
Entity Type:Individual
Prefix:
First Name:VINAYA
Middle Name:B
Last Name:CHEPURI
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:12728 19TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-225-2700
Practice Address - Fax:425-225-2790
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030762207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00030762OtherSTATE LICENSE NUMBER
WA8146672Medicaid
WA060053501OtherRAILROAD MEDICARE
WA0067761OtherLABOR AND INDUSTRY
WA0067761OtherLABOR AND INDUSTRY
WAMD00030762OtherSTATE LICENSE NUMBER