Provider Demographics
NPI:1518007004
Name:PRABHAKAR MEDICAL LLC
Entity Type:Organization
Organization Name:PRABHAKAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MECKELNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-368-8700
Mailing Address - Street 1:400 CHRISTIANA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1654
Mailing Address - Country:US
Mailing Address - Phone:302-368-8700
Mailing Address - Fax:302-368-2251
Practice Address - Street 1:400 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1654
Practice Address - Country:US
Practice Address - Phone:302-368-8700
Practice Address - Fax:302-368-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000044801Medicaid
DE0000044801Medicaid
DEG01649Medicare ID - Type UnspecifiedMEDICARE