Provider Demographics
NPI:1174510945
Name:CHOUGULE, PRAKASH B (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:B
Last Name:CHOUGULE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:450 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2715
Practice Address - Country:US
Practice Address - Phone:401-732-2300
Practice Address - Fax:401-738-3450
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD066622085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067185Medicaid
RIP01703483OtherRR MEDICARE SNERC
RI0219505OtherCIGNA
RIAA507740OtherHUMANA RWRT
RIAA507747OtherHUMANA SNERC
RI764228OtherTUFTS
RIAA507739OtherHUMANA SCRT
RIP01728458 - SCRTOtherRR MEDICARE
RIAA507747OtherHARVARD PILGRIM
RIAA507739OtherHARVARD PILGRIM
RIAA507740OtherHARVARD PILGRIM
RIP01703481OtherRR MEDICARE RWRT
RIAA507740OtherHUMANA RWRT
RI0219505OtherCIGNA
TNE97887Medicare UPIN
RIU400322039 SNERCMedicare PIN