Provider Demographics
NPI:1760529622
Name:DHARBHAMULLA, ANURADHA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:M
Last Name:DHARBHAMULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANURADHA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2114 HAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1506
Mailing Address - Country:US
Mailing Address - Phone:814-255-9949
Mailing Address - Fax:
Practice Address - Street 1:2114 HAYDEN DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1506
Practice Address - Country:US
Practice Address - Phone:814-255-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069064-L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAM33632OtherNATIONAL PROVIDER NUMBER
PAM33632OtherNATIONAL PROVIDER NUMBER