Provider Demographics
NPI:1902882541
Name:DHAND, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DHAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:GAVULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1121
Mailing Address - Country:US
Mailing Address - Phone:215-842-7415
Mailing Address - Fax:215-848-1355
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:ONE FALLS CENTER
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:215-842-7415
Practice Address - Fax:215-848-1355
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021505E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5839038OtherAETNA PPO
PA9799707OtherCIGNA
PA001613919Medicaid
PA0161391904OtherAMERICHOICE
PA431154OtherHIGHMARK BLUE SHIELD
PA0161391904OtherAMERICHOICE
PA5839038OtherAETNA PPO