Provider Demographics
NPI:1184310898
Name:PRABHAKARAN, SIVAGUHA YADUNATH (MD)
Entity type:Individual
Prefix:MR
First Name:SIVAGUHA YADUNATH
Middle Name:
Last Name:PRABHAKARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SIVAGUHA
Other - Middle Name:YADUNATH
Other - Last Name:P
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1500 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023
Mailing Address - Country:US
Mailing Address - Phone:610-237-4553
Mailing Address - Fax:
Practice Address - Street 1:1500 LANSDOWNE AVENUE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023
Practice Address - Country:US
Practice Address - Phone:610-237-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program