Provider Demographics
NPI:1770690158
Name:PABBATHI, PRAMOD K (DO)
Entity Type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:K
Last Name:PABBATHI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:285 DAVIDSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4153
Mailing Address - Country:US
Mailing Address - Phone:732-217-1400
Mailing Address - Fax:732-271-3544
Practice Address - Street 1:285 DAVIDSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4153
Practice Address - Country:US
Practice Address - Phone:732-217-1400
Practice Address - Fax:732-271-3544
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08806800207L00000X, 207LP3000X
NJMB08806800207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0376272Medicaid
NJ0376272Medicaid