Provider Demographics
NPI:1891733721
Name:LOTHE, PRADEEP AMBADAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:AMBADAS
Last Name:LOTHE
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 1:300 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2139
Mailing Address - Country:US
Mailing Address - Phone:610-649-3040
Mailing Address - Fax:610-645-0754
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2139
Practice Address - Country:US
Practice Address - Phone:610-649-3040
Practice Address - Fax:610-645-0754
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045597L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2426327002OtherHMO PROVIDER NO
PA001427145Medicaid
PA443029Medicare ID - Type Unspecified
PA2426327002OtherHMO PROVIDER NO