Provider Demographics
NPI:1174180608
Name:MANUDHANE, ALBERT PRADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PRADEEP
Last Name:MANUDHANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W 12TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-293-6255
Mailing Address - Fax:614-293-8518
Practice Address - Street 1:395 W 12TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-6255
Practice Address - Fax:614-293-8518
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04519207R00000X
OH35.144238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine