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NPI Code Detail

MEDICARE: MR. PRADEEP K MANUDHANE MD

MEDICARE: MR. PRADEEP K MANUDHANE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician35057509OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
235.05759OTHEROHLICENSE

General Provider Information

NPI Number : 1316991599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PRADEEP K MANUDHANE MD
Provider Business Mailing Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number : 330-493-4553
Fax Number : 330-493-3761
Provider Business Practice Location Address
First Line : 624 MARKET AVE N
Second Line :
City : CANTON
State : OH
Zip : 44702-1017
Country : US
Telephone Number : 330-493-4553
Fax Number : 330-493-3761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 02/15/2024

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