Provider Demographics
NPI:1073563292
Name:SADHUKHAN, MADHUMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUMITA
Middle Name:
Last Name:SADHUKHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MADHUMITA
Other - Middle Name:
Other - Last Name:CHATTERJEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:304 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3374
Mailing Address - Country:US
Mailing Address - Phone:717-735-6808
Mailing Address - Fax:717-945-1587
Practice Address - Street 1:802 NEW HOLLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2288
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:717-945-1587
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071289L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158841OtherMEDICARE GROUP NUMBER
PA0017987600001Medicaid
PAH22625Medicare PIN
PA040105Medicare PIN