Provider Demographics
NPI:1275127524
Name:PANTRANGI, MADHULATHA (PHD)
Entity Type:Individual
Prefix:
First Name:MADHULATHA
Middle Name:
Last Name:PANTRANGI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S SCHMIDT AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-2508
Mailing Address - Country:US
Mailing Address - Phone:920-268-7098
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:920-268-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics