Provider Demographics
NPI:1255393393
Name:PRADHAN, MEDHA A (MD)
Entity type:Individual
Prefix:DR
First Name:MEDHA
Middle Name:A
Last Name:PRADHAN
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 1:7205 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7101
Mailing Address - Country:US
Mailing Address - Phone:334-396-6055
Mailing Address - Fax:334-273-0952
Practice Address - Street 1:7205 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7101
Practice Address - Country:US
Practice Address - Phone:334-396-6055
Practice Address - Fax:334-273-0952
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21981208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529903260Medicaid
AL529903260Medicaid
AL000040684PRAMedicare ID - Type Unspecified