=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013986025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PADMA ADI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 09/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2614 RIVER FRONT CENTER
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-627-0628
-----------------------------------------------------
Fax | 518-627-0628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 COMANCHE TRL
-----------------------------------------------------
City | NISKAYUNA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12309-2243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-395-9215
-----------------------------------------------------
Fax | 518-395-9216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 235516
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------