Provider Demographics
NPI:1407812084
Name:BANDARI, PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:BANDARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:67 UNION ST STE 503
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-651-9503
Practice Address - Fax:508-651-9504
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3188019Medicaid
MA0026813OtherNEIGHBORHOOD HEALTH
MAJ18679OtherBLUE CROSS
MA155560OtherTUFTS
MA692705OtherHARVARD PILGRIM
MA155560OtherTUFTS
MA692705OtherHARVARD PILGRIM