Provider Demographics
NPI:1194706440
Name:PADUBIDRI, REKHA (MD)
Entity type:Individual
Prefix:DR
First Name:REKHA
Middle Name:
Last Name:PADUBIDRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE J2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4380
Mailing Address - Country:US
Mailing Address - Phone:330-726-0001
Mailing Address - Fax:330-726-1828
Practice Address - Street 1:725 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE J2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4380
Practice Address - Country:US
Practice Address - Phone:330-726-0001
Practice Address - Fax:330-726-1828
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084828207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH25215331Medicaid
OH120273Medicare UPIN
OH25215331Medicaid
OHGROUP RE9348661Medicare ID - Type Unspecified