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General NPI Number Information
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NPI Number | 1649680653
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Entity Type | Individual
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Provider Name | RADHA SADACHARAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 164 SUMMIT AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-2853
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Country | US
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Telephone | 302-528-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 BRANDYWOOD LANE
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City | WILMINGTON
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State | DE
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Zip | 19810
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Country | US
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Telephone | 302-528-8696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD15969
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License Number State | RI
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