Provider Demographics
NPI:1700825148
Name:DHADHA, ROMMEL S (MD)
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:S
Last Name:DHADHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N SENATE AVE
Mailing Address - Street 2:STE EF100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3763
Mailing Address - Country:US
Mailing Address - Phone:317-715-6402
Mailing Address - Fax:317-715-6415
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:ROOM 1204A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-6793
Practice Address - Fax:317-962-8281
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010599032085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200400090Medicaid
INP00195787OtherRAILROAD MEDICARE
IN000000556638OtherANTHEM BCBS
INP00742702OtherRAILROAD MEDICARE
IN200400090Medicaid
INP00742702OtherRAILROAD MEDICARE
IN219950JJJJMedicare PIN