Provider Demographics
NPI:1578564571
Name:SADAGOPAN, RADHIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:SADAGOPAN
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 1:113 HATCHET CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9514
Mailing Address - Country:US
Mailing Address - Phone:919-342-6683
Mailing Address - Fax:
Practice Address - Street 1:3434,KILDAIRE FARM ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-2277
Practice Address - Country:US
Practice Address - Phone:919-362-7155
Practice Address - Fax:919-362-7153
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907258Medicaid
NC5907258Medicaid