Basic Information
| Provider Information | |||||||||
| NPI: | 1497780522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KALE | ||||||||
| FirstName: | VASUDHA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATWARDHAN | ||||||||
| OtherFirstName: | VASUDHA | ||||||||
| OtherMiddleName: | DINKAR | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22 LLANFAIR RD UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190032320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107856327 | ||||||||
| FaxNumber: | 7752422409 | ||||||||
| Practice Location | |||||||||
| Address1: | 3705 5TH AVE | ||||||||
| Address2: | CHPMT 3950 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126476575 | ||||||||
| FaxNumber: | 4128028221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD432951 | PA | N | Other Service Providers | Specialist | 2085R0202X | 56057 | CT | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | MFC1577 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 2750473-00 | 05 | FL | MEDICAID |