Provider Demographics
NPI:1518086115
Name:RAJAGOPALAN, PRASHANTI (DO)
Entity Type:Individual
Prefix:
First Name:PRASHANTI
Middle Name:
Last Name:RAJAGOPALAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:859-260-4385
Mailing Address - Fax:859-260-4386
Practice Address - Street 1:610 EAST BRANNON ROAD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-260-5540
Practice Address - Fax:859-260-5545
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03216207Q00000X
PAOS0124452083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125488YJSMedicare UPIN
PA125184YJSMedicare PIN
PA125308YJOMedicare PIN
PA125488YJOMedicare UPIN