Basic Information
| Provider Information | |||||||||
| NPI: | 1821287061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVDHANI | ||||||||
| FirstName: | MADHU | ||||||||
| MiddleName: | BELUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BELUR SHIVANANDA | ||||||||
| OtherFirstName: | MADHU NAGESH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4043033759 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4043033759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 09/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD434985 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD434985 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 081535 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 211512 | 01 | PA | JOHNS HOPKINS | OTHER | 50084011 | 01 | PA | CAPITAL BLUE CROSS-WMG GBH | OTHER | 20090423 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 246429 | 01 | PA | UNISON-WMG | OTHER | 2058702 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 102179830 | 05 | PA | MEDICAID | 263666 | 01 | PA | UNISON-WMG GBH | OTHER | 30131838 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 935556-01 | 01 | MD | CAREFIRST MD BCBS | OTHER | 119590 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 50079255 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 9177182 | 01 | PA | AETNA | OTHER |