Provider Demographics
NPI:1437193190
Name:PULAKHANDAM, PADMANABHA RAO (MD)
Entity Type:Individual
Prefix:MR
First Name:PADMANABHA RAO
Middle Name:
Last Name:PULAKHANDAM
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 1:9059 56 AVENUE
Mailing Address - Street 2:APT 4A
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-699-8557
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVENUE
Practice Address - Street 2:KINGS COUNTY HOSPITAL CENTER DPT PATHOLOGY P BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-5304
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181746207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology