Healthcare Provider Details

I. General information

NPI: 1669419198
Provider Name (Legal Business Name): RADHIKA AILAWADI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COMMERCE BLVD
STROUDSBURG PA
18360
US

IV. Provider business mailing address

206 E BROWN ST POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
EAST STROUDSBURG PA
18301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 570-426-2700
  • Fax: 570-424-1252
Mailing address:
  • Phone: 570-420-4951
  • Fax: 570-476-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD429140
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD429140
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: