Individual
PRABA BOOMINATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-4206
(215) 349-8310
(215) 893-7270
Mailing address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-4206
(215) 349-8310
(215) 893-7270
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD468544
PA
Other
Enumeration date
05/18/2015
Last updated
06/21/2022
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