Provider Demographics
NPI:1154498699
Name:PATHALAPATI, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:PATHALAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MIDDLETOWN BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1818
Mailing Address - Country:US
Mailing Address - Phone:215-860-3520
Mailing Address - Fax:215-750-1660
Practice Address - Street 1:402 MIDDLETOWN BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1818
Practice Address - Country:US
Practice Address - Phone:215-860-3520
Practice Address - Fax:215-750-1660
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07560700207R00000X, 207RN0300X
PAMD430411207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021654410002Medicaid
PA1021654410001Medicaid
NJ0185582Medicaid
NJ0185582Medicaid
PA1021654410001Medicaid