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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3642
Mailing Address - Country:US
Mailing Address - Phone:215-848-9900
Mailing Address - Fax:215-848-4694
Practice Address - Street 1:5000 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3642
Practice Address - Country:US
Practice Address - Phone:215-848-9900
Practice Address - Fax:215-848-4694
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038790L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice