Provider Demographics
NPI:1467421230
Name:PRAKASH, PRANAV (MD FACOG)
Entity Type:Individual
Prefix:
First Name:PRANAV
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 ELM ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3314
Mailing Address - Country:US
Mailing Address - Phone:617-448-5938
Mailing Address - Fax:
Practice Address - Street 1:380 ELM ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-3314
Practice Address - Country:US
Practice Address - Phone:617-448-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212831207RA0401X, 207VG0400X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043288841OtherMULTIPLAN
MA110133306AOtherMASS HEALTH INDIVIDUAL PROVIDER
RI29759-2OtherBCBS OF RI
44354OtherHEALTHY START
043288841OtherCOVENTRY HEALTHCARE
043288841OtherTRICARE
MA1467421230OtherUNICARE STATE INDEMNITY (GIC)
1467421230OtherHARVARD PILGRIM HEALTHCARE
44354OtherCHILDREN'S MEDICAL SECURITY PLAN
1467421230OtherTUFTS
1467421230OtherAETNA
1053866OtherFALLON
MA110153567AOtherMASS HEALTH GROUP PROVIDER
1467421230OtherNETWORK HEALTH PLAN
MAJ25530OtherBCBS OF MA
1467421230OtherCIGNA
1467421230OtherUNITED HEALTHCARE
1467421230OtherBMC HEALTHNET
412815OtherBLUECHIP