Provider Demographics
NPI:1174543144
Name:VEDANTAM, PADMA K (MD)
Entity type:Individual
Prefix:DR
First Name:PADMA
Middle Name:K
Last Name:VEDANTAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14209 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2819
Mailing Address - Country:US
Mailing Address - Phone:954-432-2606
Mailing Address - Fax:954-894-6670
Practice Address - Street 1:7369 SHERIDAN ST, SUITE 102
Practice Address - Street 2:PEMBROKE PINES COMMUNITY BASED OUTPATIENT CLINIC
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-894-1668
Practice Address - Fax:954-894-6670
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME77780207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine