Provider Demographics
NPI:1528036084
Name:PRAKASH, KAVITHA K (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:K
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:35 SKEHAN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3737
Mailing Address - Country:US
Mailing Address - Phone:781-901-9737
Mailing Address - Fax:
Practice Address - Street 1:119 WINDSOR ST
Practice Address - Street 2:WINDSOR STREET HEALTH CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3647
Practice Address - Country:US
Practice Address - Phone:617-665-3600
Practice Address - Fax:617-665-3603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA217659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA37185Medicare ID - Type Unspecified