Provider Demographics
NPI:1366424525
Name:MADAN-KHETARPAL, SUNEETA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNEETA
Middle Name:
Last Name:MADAN-KHETARPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1135
Mailing Address - Country:US
Mailing Address - Phone:717-574-7320
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS HOSPITAL DR
Practice Address - Street 2:SUITE 1200 FACULTY PAVILLION
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1529
Practice Address - Country:US
Practice Address - Phone:412-692-6861
Practice Address - Fax:412-692-6472
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054778L207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD054778LOtherMEDICAL LICENSE NUMBER
PA001746844Medicaid
PA001746844Medicaid
PABM5378838OtherDEA NUMBER
PAF25739Medicare UPIN