Basic Information
| Provider Information | |||||||||
| NPI: | 1033328273 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ARABOLU | ||||||||
| FirstName: | PALLAVI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPARTMENT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046974201 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 154 EXTON SQUARE MALL | ||||||||
| Address2: | NEMOURS DUPONT PEDIATRICS, EXTON | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845658507 | ||||||||
| FaxNumber: | 6102801531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD444263 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 103008060 | 05 | PA | MEDICAID |