Provider Demographics
NPI:1942247945
Name:CHERUVU, RAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:
Last Name:CHERUVU
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 1:55 SPINDRIFT DR
Mailing Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7800
Mailing Address - Country:US
Mailing Address - Phone:716-631-2500
Mailing Address - Fax:716-631-1249
Practice Address - Street 1:55 SPINDRIFT DR
Practice Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-631-2500
Practice Address - Fax:716-631-1249
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2318562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02533677Medicaid
NY00027013801OtherUNIVERA
NY0005889OtherGHI
NY000527616001OtherBCBS
NY1612483OtherIHA
NY040628000067OtherFIDELIS
NY1612483OtherIHA
NYRA1770Medicare ID - Type UnspecifiedMCR