Provider Demographics
NPI:1114150612
Name:KATHPAL, MADEERA (DO)
Entity Type:Individual
Prefix:
First Name:MADEERA
Middle Name:
Last Name:KATHPAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-5046
Mailing Address - Fax:210-916-0330
Practice Address - Street 1:805 6TH AVE W STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4160
Practice Address - Country:US
Practice Address - Phone:828-696-1330
Practice Address - Fax:828-696-1075
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-029512085R0001X
PAOT012183171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOT012183OtherPHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE