Provider Demographics
NPI:1326035031
Name:KOCHERLAKOTA, PRABHAKAR (MD)
Entity Type:Individual
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First Name:PRABHAKAR
Middle Name:
Last Name:KOCHERLAKOTA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:22 SAW MILL RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-593-1606
Mailing Address - Fax:914-593-1790
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-07-15
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Provider Licenses
StateLicense IDTaxonomies
NY2400812080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783664Medicaid
NY544161Medicare PIN