Basic Information
| Provider Information | |||||||||
| NPI: | 1235447517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIDYADHARAN | ||||||||
| FirstName: | ANJANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846221000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194034243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846227100 | ||||||||
| FaxNumber: | 4846227121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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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 | 2084N0400X | MD451704 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 390200000X | R71955 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.