Provider Demographics
NPI:1891058681
Name:KADIMCHERLA, PRADEEP (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:KADIMCHERLA
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 1:33 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4512
Mailing Address - Country:US
Mailing Address - Phone:212-289-5795
Mailing Address - Fax:212-410-4424
Practice Address - Street 1:2255 ADAM CLAYTON POWELL JR BLVD # 2257
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7807
Practice Address - Country:US
Practice Address - Phone:212-281-5252
Practice Address - Fax:212-348-5194
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04345240Medicaid