Provider Demographics
NPI:1679509855
Name:PATNAIK, SUDHA R (MD)
Entity type:Individual
Prefix:
First Name:SUDHA
Middle Name:R
Last Name:PATNAIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7515 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3710
Mailing Address - Country:US
Mailing Address - Phone:267-335-5273
Mailing Address - Fax:267-335-5273
Practice Address - Street 1:7131 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3924
Practice Address - Country:US
Practice Address - Phone:215-821-2305
Practice Address - Fax:215-220-2600
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038790L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice