Individual
PADMANABHA RENGABHASHYAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 EAST BROWN STREET, EAST STROUDSBURG, EAST STROUDSBURG, PA 18301-3094
(570) 476-3475
(703) 563-6256
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5102
(703) 563-6256
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD427232
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014272460001
—
PA
Enumeration date
04/06/2006
Last updated
09/02/2016
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