Provider Demographics
NPI:1275737371
Name:WADEHRA, DAVINDER (MD)
Entity Type:Individual
Prefix:
First Name:DAVINDER
Middle Name:
Last Name:WADEHRA
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 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3431
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SUITE 2700
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-7465
Practice Address - Fax:513-475-8244
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247237207R00000X, 207RN0300X
LA202761207R00000X
OH35-095180207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1961655Medicaid
OH3040220Medicaid
OH3040220Medicaid
OH4289581Medicare PIN