Provider Demographics
NPI:1689110611
Name:POPHALI, PRACHI AVINASH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRACHI
Middle Name:AVINASH
Last Name:POPHALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 EASTON AVE
Mailing Address - Street 2:4TH FLOOR CARES, RM 4014
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1723
Mailing Address - Country:US
Mailing Address - Phone:913-548-3576
Mailing Address - Fax:
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5099
Practice Address - Country:US
Practice Address - Phone:262-928-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine