Provider Demographics
NPI:1306008818
Name:PADMANABHUNI, AMITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITHA
Middle Name:
Last Name:PADMANABHUNI
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 1:1001 CHESTERBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-3805
Mailing Address - Country:US
Mailing Address - Phone:610-576-7800
Mailing Address - Fax:
Practice Address - Street 1:1001 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312
Practice Address - Country:US
Practice Address - Phone:610-576-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437513207RE0101X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037276OtherMLHC MEDICARE AA #
PA1922077643OtherMLHC GROUP NPI #
PA824305OtherBS AA #
PA1922077643OtherMLHC GROUP NPI #