Provider Demographics
NPI:1922009935
Name:PRASHER, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:PRASHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ROBESON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5640
Mailing Address - Country:US
Mailing Address - Phone:910-484-4100
Mailing Address - Fax:910-484-4179
Practice Address - Street 1:2301 ROBESON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5640
Practice Address - Country:US
Practice Address - Phone:910-484-4100
Practice Address - Fax:910-484-4179
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301160207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135R3Medicaid
NCP00074543OtherRAIL ROAD MEDICARE
NC2022837Medicare PIN
NC89135R3Medicaid