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NPI Code Detail

MEDICARE: DR. PRADEEP K PRADHAN MD

MEDICARE: DR. PRADEEP K PRADHAN 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
1207R00000XInternal Medicine Physician0101053120VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1280236OTHERVAANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568465854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRADEEP K PRADHAN MD
Provider Business Mailing Address
First Line : 414 PARK AVE
Second Line : STE F
City : DANVILLE
State : VA
Zip : 24541-4630
Country : US
Telephone Number : 434-857-3600
Fax Number : 434-200-1654
Provider Business Practice Location Address
First Line : 414 PARK AVE
Second Line : STE F
City : DANVILLE
State : VA
Zip : 24541-4630
Country : US
Telephone Number : 434-857-3600
Fax Number : 434-200-1654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 04/28/2017

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