Provider Demographics
NPI:1972566099
Name:KAKODKAR, VASUNDHARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUNDHARA
Middle Name:S
Last Name:KAKODKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 HAY TERRACE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4615
Mailing Address - Country:US
Mailing Address - Phone:610-252-3042
Mailing Address - Fax:610-253-0831
Practice Address - Street 1:1922 HAY TER
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4615
Practice Address - Country:US
Practice Address - Phone:610-252-3042
Practice Address - Fax:610-253-0831
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040255E2080I0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64278Medicare UPIN