Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA06689700 | NJ |
N | 208000000X | Pediatrician | MD065201L | PA |
N | 2080P0210X | Pediatric Nephrologist | 25MA06689700 | NJ |
Y | 2080P0210X | Pediatric Nephrologist | MD065201L | PA |
NPI | 1285640367 |
---|---|
Provider Name | Madhura R Pradhan |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 12/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001844077 | (05) | PA |
8530408 | (05) | NJ |
H37447 | (02) |