Individual
DIVYA MADHUSUDHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(800) 879-2467
Mailing address
5217 TULIP LEAF CT, CENTREVILLE, VA 20120-6112
(540) 878-8329
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
MT227979
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2018
Last updated
06/23/2023
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