Provider Demographics
NPI:1477537876
Name:RAMACHANDRA, PRASHANTH R
Entity Type:Individual
Prefix:DR
First Name:PRASHANTH
Middle Name:R
Last Name:RAMACHANDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6170
Practice Address - Fax:610-534-6159
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422173208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009133790003Medicaid
PA3956575OtherAETNA HMO
PA1009133790003Medicaid
PA2213655000OtherKEYSTONE HEALTH PLAN EAST
PA30023893OtherKEYSTONE MERCY
PA1527841OtherBLUE SHIELD
PA073425R83Medicare PIN