Provider Demographics
NPI:1114092186
Name:JAJODIA, PRAHALAD B (MD)
Entity Type:Individual
Prefix:MR
First Name:PRAHALAD
Middle Name:B
Last Name:JAJODIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7687 N KAVANAGH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0362
Mailing Address - Country:US
Mailing Address - Phone:559-273-0600
Mailing Address - Fax:559-433-9008
Practice Address - Street 1:7085 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8011
Practice Address - Country:US
Practice Address - Phone:559-431-8888
Practice Address - Fax:559-447-8400
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A560840207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61010Medicare UPIN
0DA560840Medicare ID - Type Unspecified