Provider Demographics
NPI:1619056082
Name:PRAHALAD B JAJODIA MD INC
Entity Type:Organization
Organization Name:PRAHALAD B JAJODIA MD INC
Other - Org Name:DIGESTIVE AND LIVER DISEASE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAHALAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAJODIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-431-8888
Mailing Address - Street 1:9865 NORTH SEDONA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5408
Mailing Address - Country:US
Mailing Address - Phone:559-273-0600
Mailing Address - Fax:559-433-9008
Practice Address - Street 1:6137 NORTH THESTA AVE
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8605
Practice Address - Country:US
Practice Address - Phone:559-431-8888
Practice Address - Fax:559-447-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A560840207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61010Medicare UPIN