Individual
MAHESH KRISHNA VIDULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST., PHILADELPHIA, PA 19104-4206
(215) 662-7355
(215) 349-8444
Mailing address
3400 SPRUCE ST., PHILADELPHIA, PA 19104-4206
(215) 662-7355
(215) 349-8444
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD473523
PA
207RC0000X
Cardiovascular Disease Physician
25MA11455300
NJ
207RC0000X
Cardiovascular Disease Physician
Primary
MD473523
PA
Other
Enumeration date
02/01/2015
Last updated
11/23/2022
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