Provider Demographics
NPI:1437462710
Name:DHAMDHERE, MEGHANA VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:MEGHANA
Middle Name:VIJAY
Last Name:DHAMDHERE
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 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-2529
Practice Address - Fax:610-237-4261
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011024207R00000X
PAMT196374208600000X
PAMD464695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103793541Medicaid