Provider Demographics
NPI:1790730570
Name:MADNANI, SANJAY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:M
Last Name:MADNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MIDDLETOWN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3202
Mailing Address - Country:US
Mailing Address - Phone:215-741-7031
Mailing Address - Fax:215-741-4470
Practice Address - Street 1:300 MIDDLETOWN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3202
Practice Address - Country:US
Practice Address - Phone:215-741-7031
Practice Address - Fax:215-741-4470
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4318892081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40122Medicare UPIN