Provider Demographics
NPI:1891742441
Name:PADMANABHAN, ANANTANARAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANTANARAYAN
Middle Name:
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANANTANARAYAN
Other - Middle Name:
Other - Last Name:PADMANABHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:1791 E FIR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3840
Practice Address - Country:US
Practice Address - Phone:559-326-1222
Practice Address - Fax:559-326-1230
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31247207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19841ZMedicare ID - Type Unspecified
CAZZZ37565ZMedicare ID - Type Unspecified
CAA87535Medicare UPIN