Provider Demographics
NPI:1265815500
Name:VACHHANI, RADHIKA
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:VACHHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:610-969-1917
Mailing Address - Fax:484-664-7659
Practice Address - Street 1:3080 HAMILTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3694
Practice Address - Country:US
Practice Address - Phone:610-437-0739
Practice Address - Fax:610-437-3601
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD465689207R00000X
MI4301107671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics