Provider Demographics
NPI:1346336559
Name:KANCHERLA, PRAKASH SURYA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:SURYA
Last Name:KANCHERLA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2358 CROTONA AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8571
Mailing Address - Country:US
Mailing Address - Phone:718-733-2600
Mailing Address - Fax:718-562-2281
Practice Address - Street 1:2358 CROTONA AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8571
Practice Address - Country:US
Practice Address - Phone:718-733-2600
Practice Address - Fax:718-562-2281
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY130852208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics