Provider Demographics
NPI:1326008582
Name:DAVE, PRAFULL K (MD PA)
Entity Type:Individual
Prefix:DR
First Name:PRAFULL
Middle Name:K
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5181
Mailing Address - Country:US
Mailing Address - Phone:301-898-3010
Mailing Address - Fax:301-695-5485
Practice Address - Street 1:188 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-898-3010
Practice Address - Fax:301-695-5485
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4059021Medicare PIN
MD3114Medicare PIN