Provider Demographics
NPI:1609936376
Name:PRAHLAD, ASHOK PETE (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:PETE
Last Name:PRAHLAD
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:12255 FAIR LAKES PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4518
Practice Address - Country:US
Practice Address - Phone:703-934-5700
Practice Address - Fax:703-934-5778
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039032208600000X
MDD0070730208600000X
DCMD038685208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
466515M92Medicare ID - Type Unspecified
B95077Medicare UPIN