Provider Demographics
NPI:1487648069
Name:KAKARLA, RADHIKA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:PRASAD
Last Name:KAKARLA
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 1:85 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2544
Mailing Address - Country:US
Mailing Address - Phone:610-971-9461
Mailing Address - Fax:610-688-4490
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD
Practice Address - Street 2:101
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-2544
Practice Address - Country:US
Practice Address - Phone:610-971-9461
Practice Address - Fax:610-688-4490
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1902174400000X
PAMD428592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX243721OtherAMERIGROUP
TXL1902OtherUNICARE
TX147917201Medicaid
TX89301XOtherBCBS INSURANCE CO
TXA007OtherTRICARE
TX2386281OtherAETNA INSURANCE CO
TXA007OtherTRICARE
TX147917201Medicaid