Provider Demographics
NPI:1275276792
Name:NIDASALE PRAKASH, PRIYANKA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:NIDASALE 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 1:3201 SPRINGHILL DR, SUITE 100
Mailing Address - Street 2:IM RESIDENTS, BAPTIST HEALTH INTERNAL MEDICINE CLINIC
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2905
Mailing Address - Country:US
Mailing Address - Phone:501-955-4530
Mailing Address - Fax:501-955-4540
Practice Address - Street 1:3201 SPRINGHILL DR, SUITE 100
Practice Address - Street 2:IM RESIDENTS, BAPTIST HEALTH INTERNAL MEDICINE CLINIC
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2905
Practice Address - Country:US
Practice Address - Phone:501-955-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program