Provider Demographics
NPI:1821521733
Name:TRIVEDI, RADHIKA RANI (MD; MPH)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:RANI
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD; MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4464
Mailing Address - Country:US
Mailing Address - Phone:850-233-3376
Mailing Address - Fax:
Practice Address - Street 1:11975 MORRIS RD STE 310A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4419
Practice Address - Country:US
Practice Address - Phone:877-231-3376
Practice Address - Fax:949-760-0439
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176430207N00000X
GA96866207N00000X
PAMT216944207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty