Provider Demographics
NPI:1790808558
Name:PULAKHANDAM, USHA R (MD)
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:R
Last Name:PULAKHANDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9059 56TH AVE
Mailing Address - Street 2:APT 4A
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4944
Mailing Address - Country:US
Mailing Address - Phone:718-699-8557
Mailing Address - Fax:718-699-8557
Practice Address - Street 1:9002 QUEENS BLVD
Practice Address - Street 2:ST. VINCENTS CATHOLIC MEDICAL CENTER
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-558-1720
Practice Address - Fax:718-558-1783
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178287-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology