Provider Demographics
NPI:1447578182
Name:BURBANO DE LARA, PRARDHANA CHALLAPALLI (MD)
Entity Type:Individual
Prefix:
First Name:PRARDHANA
Middle Name:CHALLAPALLI
Last Name:BURBANO DE LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRARDHANA
Other - Middle Name:
Other - Last Name:CHALLAPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 1900
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-6510
Mailing Address - Fax:302-733-3340
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1900
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-6510
Practice Address - Fax:302-733-3340
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN14645207V00000X
CAA131790207V00000X
WAMD60847114207V00000X
DEC1-0025334207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology