Provider Demographics
NPI:1679506885
Name:PRASAD.A.IRAGAVARAPU, M.D, P.A
Entity Type:Organization
Organization Name:PRASAD.A.IRAGAVARAPU, M.D, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:ACHYUTA
Authorized Official - Last Name:IRAGAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-997-8531
Mailing Address - Street 1:6670 NEWPORT LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3001
Mailing Address - Country:US
Mailing Address - Phone:561-997-8531
Mailing Address - Fax:
Practice Address - Street 1:6670 NEWPORT LAKE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3001
Practice Address - Country:US
Practice Address - Phone:561-997-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0039794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61261AMedicare ID - Type Unspecified