Healthcare Provider Details

I. General information

NPI: 1134183585
Provider Name (Legal Business Name): REKHA PANDULA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARKET ST 9TH FL
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3737 MARKET ST 9TH FL
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9700
  • Fax:
Mailing address:
  • Phone: 215-662-9700
  • Fax: 717-544-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberN4647
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD435531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: