1235132317 NPI number — PRAKASH D ADAWADKAR M.D.

Table of content: PRAKASH D ADAWADKAR M.D. (NPI 1235132317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235132317 NPI number — PRAKASH D ADAWADKAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAWADKAR
Provider First Name:
PRAKASH
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235132317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 DALE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALE CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22193-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-670-0300
Provider Business Mailing Address Fax Number:
703-670-6759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 DALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALE CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22193-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-670-0300
Provider Business Practice Location Address Fax Number:
703-670-6759
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101044728 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 501200 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639078 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 451503 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 878906 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10005 . This is a "UNICARE-MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006708005 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 955166 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: B337-0001 . This is a "CARE FIRST BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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