Provider Demographics
NPI:1033197389
Name:PRABHAKAR, SHASHI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:KUMAR
Last Name:PRABHAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-794-6400
Mailing Address - Fax:804-897-0910
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-794-6400
Practice Address - Fax:804-897-0910
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232902207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09462OtherGROUP PTAN
VAC09462OtherGROUP PTAN