Provider Demographics
NPI:1922292911
Name:SONAVANE, VIDYA K (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:K
Last Name:SONAVANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIDYA
Other - Middle Name:K
Other - Last Name:SONAVANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2801 FOREST HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-6343
Mailing Address - Country:US
Mailing Address - Phone:732-318-6809
Mailing Address - Fax:
Practice Address - Street 1:2801 FOREST HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-6343
Practice Address - Country:US
Practice Address - Phone:732-318-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08454600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics