Provider Demographics
NPI:1184678161
Name:PRAKASH, ASHA S (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:S
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 DELAWARE AVENUE
Mailing Address - Street 2:VA CLINIC MARION CBOC
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6419
Mailing Address - Country:US
Mailing Address - Phone:614-257-5930
Mailing Address - Fax:614-257-5922
Practice Address - Street 1:1203 DELAWARE AVENUE
Practice Address - Street 2:VA CLINIC MARION CBOC
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6419
Practice Address - Country:US
Practice Address - Phone:614-257-5930
Practice Address - Fax:614-257-5922
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine