Healthcare Provider Details

I. General information

NPI: 1366440455
Provider Name (Legal Business Name): MADHAVAN V. PILLAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT STREET SUITE 320A
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT STREET SUITE 320A
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8874
  • Fax: 215-955-2340
Mailing address:
  • Phone: 215-955-8874
  • Fax: 215-955-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101032256
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD439889
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM13436
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: