Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 217991 | MA |
NPI | 1003853698 |
---|---|
Provider Name | Rajeev Prasad |
First Address | Philadelphia, PA 19134-1043 |
Second Address | Philadelphia, PA 19134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 10/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0124966 | (05) | NJ |
H98537 | (02) | PA |