Healthcare Provider Details

I. General information

NPI: 1902911670
Provider Name (Legal Business Name): AVINASH C PRADHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD CAVHCS
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

215 PERRY HILL RD CAVHCS
MONTGOMERY AL
36109-3725
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax: 334-273-6225
Mailing address:
  • Phone: 334-272-4670
  • Fax: 334-273-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD7757
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: