Provider Demographics
NPI:1801824354
Name:PRAWAK, ADRIANA S (DO)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:S
Last Name:PRAWAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-789-7767
Mailing Address - Fax:610-789-7768
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4539
Practice Address - Country:US
Practice Address - Phone:610-789-7767
Practice Address - Fax:610-789-7768
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009727L2081S0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018475700003Medicaid
PA049831Medicare ID - Type Unspecified
H21168Medicare UPIN