Provider Demographics
NPI:1134144330
Name:SESHADRI, PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:SESHADRI
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 1:3506 KENNETT PIKE
Mailing Address - Street 2:PMRI
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-3019
Mailing Address - Country:US
Mailing Address - Phone:302-661-3070
Mailing Address - Fax:302-661-3080
Practice Address - Street 1:3506 KENNETT PIKE
Practice Address - Street 2:CCHS DIABETES AND METABOLIC DISEASE CENTER
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-3019
Practice Address - Country:US
Practice Address - Phone:302-661-3070
Practice Address - Fax:302-661-3080
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008054207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82085Medicare UPIN
DE019879C04Medicare PIN
DE020558C49Medicare PIN