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General NPI Number Information
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NPI Number | 1447579537
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Entity Type | Organization
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Legal Business Name | PRADEEP MANUDHANE MD
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 1207 W STATE ST SUITE M
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City | ALLIANCE
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State | OH
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Zip | 44601-4686
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Country | US
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Telephone | 330-821-8047
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Fax | 330-821-9372
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Provider Business Mailing Address
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Address Line | 1207 W STATE ST SUITE M
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City | ALLIANCE
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State | OH
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Zip | 44601-4686
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Country | US
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Telephone | 330-821-8047
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Fax | 330-821-9372
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Authorized Official
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Title or Position | MD
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Name | PRADEEP MANUDHANE
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Credential | MD
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Telephone | 330-821-8047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 35057509
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License Number State | OH
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