Provider Demographics
NPI:1780653634
Name:PODUGU, RADHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:PODUGU
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 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:SUITE#500
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-452-8858
Mailing Address - Fax:330-452-7797
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE#500
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-452-8858
Practice Address - Fax:330-452-7797
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071855P207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017936Medicaid
OHPO4030902Medicare PIN
OH2017936Medicaid
OHMA9258631Medicare ID - Type UnspecifiedGROUP