Provider Demographics
NPI:1679713887
Name:SUDHAKAR, PADMAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:
Last Name:SUDHAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PADMAJA
Other - Middle Name:
Other - Last Name:MINAKSHISUNDARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:ROOM L445
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-218-5038
Mailing Address - Fax:859-323-5943
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-218-5038
Practice Address - Fax:859-323-5943
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48041207WX0109X, 2084N0400X
KYR26522084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program