Provider Demographics
NPI:1295820934
Name:PRASHAD, JAIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIRAJ
Middle Name:
Last Name:PRASHAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1444 BARNWELL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-256-6274
Mailing Address - Fax:803-256-6275
Practice Address - Street 1:1444 BARNWELL ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-256-6274
Practice Address - Fax:803-256-6275
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2009643207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC096434PA5093Medicaid
C61416Medicare UPIN
SC096434PA5093Medicaid