Individual
PRADEEP R. BANKULLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4900 FRANKFORD AVE, ATTN: RADIOLOGY, PHILADELPHIA, PA 19124-2618
(602) 910-6887
(215) 612-5077
Mailing address
PO BOX 782743, ATTN: CREDENTIALING, PHILADELPHIA, PA 19178-2743
(602) 910-6887
(215) 612-5077
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA08298700
NJ
2085R0202X
Diagnostic Radiology Physician
Primary
MD431933
PA
2085R0204X
Vascular & Interventional Radiology Physician
25MA08298700
NJ
2085R0204X
Vascular & Interventional Radiology Physician
MD431933
PA
Other
Enumeration date
06/10/2006
Last updated
07/26/2019
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