Provider Demographics
NPI:1134183585
Name:PANDULA, REKHA (MD)
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:PANDULA
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 1:3737 MARKET ST
Mailing Address - Street 2:9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-9700
Mailing Address - Fax:717-544-3638
Practice Address - Street 1:3737 MARKET ST
Practice Address - Street 2:9TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4647207RE0101X
PAMD435531207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01437140OtherRR MEDICARE
TX8FT337OtherBLUE CROSS BLUE SHIELD
TX207646503Medicaid
TX207646504Medicaid
TX8EJ187OtherBLUE CROSS BLUE SHIELD
TX8CN620OtherBCBS
TX207646504Medicaid
TX207646503Medicaid
TX365091YMVQMedicare PIN