Provider Demographics
NPI:1346230687
Name:ASHOK, PUDUCHREI S (MD)
Entity type:Individual
Prefix:DR
First Name:PUDUCHREI
Middle Name:S
Last Name:ASHOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5500 BROOKTREE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9260
Mailing Address - Country:US
Mailing Address - Phone:724-933-1420
Mailing Address - Fax:724-933-1439
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:724-933-1420
Practice Address - Fax:724-933-1439
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028657E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012856200006Medicaid
PA0012856200006Medicaid
PA187030E81Medicare PIN