Provider Demographics
NPI:1710181557
Name:JAIRAJ PRASHAD MD PA
Entity Type:Organization
Organization Name:JAIRAJ PRASHAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-256-6274
Mailing Address - Street 1:1444 BARNWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3512
Mailing Address - Country:US
Mailing Address - Phone:803-256-6274
Mailing Address - Fax:803-256-6275
Practice Address - Street 1:1444 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3512
Practice Address - Country:US
Practice Address - Phone:803-256-6274
Practice Address - Fax:803-256-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9643207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC61416Medicare UPIN