Provider Demographics
NPI:1639415649
Name:PRAKASH CHAND M.D. INC
Entity Type:Organization
Organization Name:PRAKASH CHAND M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-897-4463
Mailing Address - Street 1:125 E BROAD ST
Mailing Address - Street 2:SUITE#122
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6400
Mailing Address - Country:US
Mailing Address - Phone:440-329-7350
Mailing Address - Fax:440-329-7349
Practice Address - Street 1:125 EAST BROAD STREET
Practice Address - Street 2:SUITE#122
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6429
Practice Address - Country:US
Practice Address - Phone:440-329-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
097256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055719Medicaid