Basic Information
| Provider Information | |||||||||
| NPI: | 1114150612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATHPAL | ||||||||
| FirstName: | MADEERA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165046 | ||||||||
| FaxNumber: | 2109160330 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 6TH AVE W STE 100 | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286961330 | ||||||||
| FaxNumber: | 8286961075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 2018-02951 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 171000000X | OT012183 | PA | N | Other Service Providers | Military Health Care Provider |
ID Information
| ID | Type | State | Issuer | Description | OT012183 | 01 | PA | PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE | OTHER |