Provider Demographics
NPI:1982349601
Name:PRADHAN, KRISTINA (MBBS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DATES DRIVE
Mailing Address - Street 2:ATTN INTERNAL MEDICINE RESIDENCY
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-274-4225
Mailing Address - Fax:607-274-4587
Practice Address - Street 1:101 DATES DRIVE, CAYUGA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-4225
Practice Address - Fax:607-274-4587
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2023-03-08
Deactivation Date:2023-02-08
Deactivation Code:
Reactivation Date:2023-03-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program