Provider Demographics
NPI:1124244587
Name:PRADHAN, DEEPAK RAVINDRA (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:RAVINDRA
Last Name:PRADHAN
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 1:60 RIVERSIDE BLVD
Mailing Address - Street 2:APT. 816
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0201
Mailing Address - Country:US
Mailing Address - Phone:215-880-6674
Mailing Address - Fax:
Practice Address - Street 1:164 SUMMIT AVE.
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-793-2104
Practice Address - Fax:401-793-4047
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY258094207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease