Healthcare Provider Details

I. General information

NPI: 1386099968
Provider Name (Legal Business Name): RADHIKA CHANDRAMOULI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 VILLAGE LN
MACUNGIE PA
18062-8484
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-967-2772
  • Fax: 610-967-2599
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD466719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: