Provider Demographics
NPI:1811955149
Name:KADAKIA, PRADIP R (MBBS)
Entity type:Individual
Prefix:
First Name:PRADIP
Middle Name:R
Last Name:KADAKIA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:PRADIPKUMAR
Other - Middle Name:R
Other - Last Name:KADAKIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-1304
Mailing Address - Fax:585-922-1399
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-338-4941
Practice Address - Fax:585-467-4626
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY00027337101OtherUNIVERA
NY10498512OtherCAQH
NY0191954OtherIHA
NY101427DLOtherPREFERRED CARE
NYP010189642OtherBLUE CHOICE
NY10498512OtherCAQH