Provider Demographics
NPI:1851321806
Name:PADIVAL, PRADYUMNA KUMAR (MD,FACC)
Entity Type:Individual
Prefix:DR
First Name:PRADYUMNA
Middle Name:KUMAR
Last Name:PADIVAL
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:419-520-2495
Mailing Address - Fax:
Practice Address - Street 1:275 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1000
Practice Address - Country:US
Practice Address - Phone:419-756-2177
Practice Address - Fax:419-756-7275
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042607207RC0000X
OH35.042607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0366876Medicaid
OHCO1775Medicare UPIN
OHPA0472694Medicare ID - Type Unspecified