Provider Demographics
NPI:1952306292
Name:CHANDRA PRAKASH, APARNA (MD)
Entity Type:Individual
Prefix:DR
First Name:APARNA
Middle Name:
Last Name:CHANDRA PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:MAIL CODE SO10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:440-519-6800
Mailing Address - Fax:440-519-6908
Practice Address - Street 1:29800 BAINBRIDGE RD
Practice Address - Street 2:MAIL CODE SO10
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2202
Practice Address - Country:US
Practice Address - Phone:440-519-6800
Practice Address - Fax:440-519-6908
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088973207R00000X
WI42355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2719080Medicaid
WI34013900Medicaid
WI34013900Medicaid
H23213Medicare UPIN
OH2719080Medicaid