Provider Demographics
NPI:1861627796
Name:PRABHU, SANJAY P (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:P
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON/RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6936
Mailing Address - Fax:617-730-0549
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON/RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6936
Practice Address - Fax:617-730-0549
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2014-06-03
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Provider Licenses
StateLicense IDTaxonomies
MA239721282NC2000X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No282NC2000XHospitalsGeneral Acute Care HospitalChildren