Provider Demographics
NPI:1174663207
Name:HOLLA, PRASHANTHA DEVIDAS (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANTHA
Middle Name:DEVIDAS
Last Name:HOLLA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-595-2021
Practice Address - Street 1:378 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2673
Practice Address - Country:US
Practice Address - Phone:508-595-2513
Practice Address - Fax:508-595-2021
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA230969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110077201AMedicaid