Provider Demographics
NPI:1912902081
Name:BAIKADI, MADHAVA (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVA
Middle Name:
Last Name:BAIKADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1094
Mailing Address - Country:US
Mailing Address - Phone:570-504-7210
Mailing Address - Fax:570-955-2213
Practice Address - Street 1:1110 MEADE ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3169
Practice Address - Country:US
Practice Address - Phone:570-504-7200
Practice Address - Fax:570-504-7209
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-027885-E174400000X
PAMD 027885E2085R0203X
PAMD027885E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001086752Medicaid
PA001086752Medicaid
PAB38572Medicare UPIN