Healthcare Provider Details

I. General information

NPI: 1518667948
Provider Name (Legal Business Name): INDU CHERANGAPADATH RADHAKRISHNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6784 MARKET ST
UPPER DARBY PA
19082-2431
US

IV. Provider business mailing address

1000 CONESTOGA RD APT C259
BRYN MAWR PA
19010-1547
US

V. Phone/Fax

Practice location:
  • Phone: 484-462-0171
  • Fax:
Mailing address:
  • Phone: 484-744-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044195
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: