Provider Demographics
NPI:1891101986
Name:GUDDETI, RAVITEJA (MD)
Entity Type:Individual
Prefix:
First Name:RAVITEJA
Middle Name:
Last Name:GUDDETI
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 1:2301 ROBESON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5641
Mailing Address - Country:US
Mailing Address - Phone:910-484-4100
Mailing Address - Fax:910-484-4179
Practice Address - Street 1:2301 ROBESON ST STE 301
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5641
Practice Address - Country:US
Practice Address - Phone:910-484-4100
Practice Address - Fax:910-484-4179
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2021-00562207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program