Provider Demographics
NPI:1235132317
Name:ADAWADKAR, PRAKASH D (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:D
Last Name:ADAWADKAR
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 1:4201 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:DALE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2243
Mailing Address - Country:US
Mailing Address - Phone:703-670-0300
Mailing Address - Fax:703-670-6759
Practice Address - Street 1:4201 DALE BLVD
Practice Address - Street 2:
Practice Address - City:DALE CITY
Practice Address - State:VA
Practice Address - Zip Code:22193-2243
Practice Address - Country:US
Practice Address - Phone:703-670-0300
Practice Address - Fax:703-670-6759
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA501200OtherNCPPO
VA1639078OtherCIGNA
VA451503OtherANTHEM BLUE CROSS
VA878906OtherMAMSI
VA10005OtherUNICARE-MEDICAID
VA006708005Medicaid
VA955166OtherUNITED HEALTHCARE
VAB337-0001OtherCARE FIRST BLUE CROSS