Provider Demographics
NPI:1568550689
Name:PRAKASH, CHAKRAPANI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAKRAPANI
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 1:9 HOSPITAL DR
Mailing Address - Street 2:SUITE B2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6425
Mailing Address - Country:US
Mailing Address - Phone:732-505-4420
Mailing Address - Fax:732-505-0328
Practice Address - Street 1:9 HOSPITAL DR
Practice Address - Street 2:SUITE B2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6425
Practice Address - Country:US
Practice Address - Phone:732-505-4420
Practice Address - Fax:732-505-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA052242207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0349801Medicaid
NJ566818Medicare ID - Type Unspecified
NJ0349801Medicaid