Provider Demographics
NPI:1013142439
Name:ANANDAPPA, ROSHANI THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANI
Middle Name:THERESE
Last Name:ANANDAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1233 LOCUST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5453
Practice Address - Country:US
Practice Address - Phone:215-545-8188
Practice Address - Fax:215-545-8446
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2011-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 435442208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN