Basic Information
| Provider Information | |||||||||
| NPI: | 1386665636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHOLAKIA | ||||||||
| FirstName: | MADHURI | ||||||||
| MiddleName: | ANIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2673393761 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE STE 1300 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673397843 | ||||||||
| FaxNumber: | 2673393763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD428738 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 25MA08176700 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | MD428738 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7353868 | 01 | AETNA | OTHER | 2745732000 | 01 | PA | IBC PA | OTHER | 1941773 | 01 | CIGNA | OTHER | 2817992000 | 01 | NJ | IBC NJ | OTHER |