Provider Demographics
NPI:1598980724
Name:PRAVS, DAILA MELITA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAILA
Middle Name:MELITA
Last Name:PRAVS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WALNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3505
Mailing Address - Country:US
Mailing Address - Phone:215-955-1730
Mailing Address - Fax:215-955-8592
Practice Address - Street 1:700 WALNUT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3505
Practice Address - Country:US
Practice Address - Phone:215-955-1730
Practice Address - Fax:215-955-8592
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186591207Q00000X
PAMD433546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102598417 0002Medicaid
PA102598417 0001Medicaid
PA127649Medicare PIN