Provider Demographics
NPI:1821287061
Name:AVDHANI, MADHU BELUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:BELUR
Last Name:AVDHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MADHU NAGESH
Other - Middle Name:
Other - Last Name:BELUR SHIVANANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-303-3759
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-303-3759
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434985207R00000X, 208M00000X
GA081535208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA211512OtherJOHNS HOPKINS
PA50084011OtherCAPITAL BLUE CROSS-WMG GBH
PA20090423OtherAMERIHEALTH MERCY-WMG
PA246429OtherUNISON-WMG
PA2058702OtherHIGHMARK BLUE SHIELD
PA102179830Medicaid
PA263666OtherUNISON-WMG GBH
PA30131838OtherAMERIHEALTH MERCY - WMG
MD935556-01OtherCAREFIRST MD BCBS
PA119590OtherGEISINGER HEALTH PLAN
PA50079255OtherCAPITAL BLUE CROSS-WMG
PA9177182OtherAETNA
PA128542FLTMedicare PIN
PA30131838OtherAMERIHEALTH MERCY - WMG
PA102179830Medicaid