Provider Demographics
NPI:1861684094
Name:KUDAGI, VINOD S (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:S
Last Name:KUDAGI
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 1:1469 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2256
Mailing Address - Country:US
Mailing Address - Phone:484-526-7800
Mailing Address - Fax:484-526-7810
Practice Address - Street 1:1469 8TH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2256
Practice Address - Country:US
Practice Address - Phone:484-526-7800
Practice Address - Fax:484-526-7810
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459779207RI0011X
NY254755207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03831830Medicaid
NY03831830Medicaid