Provider Demographics
NPI:1700058328
Name:PURUSHOTHAMAN, RADHIKA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:PURUSHOTHAMAN
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 ROBLE AVE
Mailing Address - Street 2:APT. NO. 3
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4947
Mailing Address - Country:US
Mailing Address - Phone:610-864-9597
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:CHILDREN'S HOSPITAL OAKLAND
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1152712080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology