Provider Demographics
NPI:1447579537
Name:PRADEEP MANUDHANE MD
Entity Type:Organization
Organization Name:PRADEEP MANUDHANE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUDHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-821-8047
Mailing Address - Street 1:1207 W STATE ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4686
Mailing Address - Country:US
Mailing Address - Phone:330-821-8047
Mailing Address - Fax:330-821-9372
Practice Address - Street 1:1207 W STATE ST
Practice Address - Street 2:SUITE M
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4686
Practice Address - Country:US
Practice Address - Phone:330-821-8047
Practice Address - Fax:330-821-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350575092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMA0679455Medicare PIN