Provider Demographics
NPI:1811135114
Name:FADULU, VAN THANH (MS)
Entity type:Individual
Prefix:MS
First Name:VAN
Middle Name:THANH
Last Name:FADULU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:VAN
Other - Middle Name:THANH
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3630 SHADY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4850
Mailing Address - Country:US
Mailing Address - Phone:832-978-3833
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT EAST
Practice Address - Street 2:SUITE 1250
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4419
Practice Address - Country:US
Practice Address - Phone:215-351-2332
Practice Address - Fax:215-351-0586
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS