Provider Demographics
NPI:1376587592
Name:PRABHA, CHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:PRABHA
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 1:110 N 29TH ST
Mailing Address - Street 2:STE. 302
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4461
Mailing Address - Country:US
Mailing Address - Phone:402-844-8190
Mailing Address - Fax:402-844-8191
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:STE. 302
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4461
Practice Address - Country:US
Practice Address - Phone:402-844-8190
Practice Address - Fax:402-844-8191
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00255285OtherRR
NE247335OtherMIDLANDS CHOICE
NE30075OtherBCBSNE
NE30075OtherBCBSNE
NE279098Medicare ID - Type Unspecified