Provider Demographics
NPI:1558398115
Name:PRAKASH, RAMANATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANATHAN
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3839
Mailing Address - Country:US
Mailing Address - Phone:661-945-5323
Mailing Address - Fax:661-945-3252
Practice Address - Street 1:1011 E AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3839
Practice Address - Country:US
Practice Address - Phone:661-945-5323
Practice Address - Fax:661-945-3252
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 384842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 38484Medicare ID - Type Unspecified