Provider Demographics
NPI:1437854742
Name:PRADHAN, PRABIN
Entity Type:Individual
Prefix:
First Name:PRABIN
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3063
Mailing Address - Country:US
Mailing Address - Phone:234-417-4480
Mailing Address - Fax:
Practice Address - Street 1:159 NORTHWOOD LN
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3063
Practice Address - Country:US
Practice Address - Phone:234-417-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant