Provider Demographics
NPI:1205066065
Name:BAJRACHARYA, PRABESH (MD)
Entity type:Individual
Prefix:
First Name:PRABESH
Middle Name:
Last Name:BAJRACHARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:1022 N BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3316
Practice Address - Country:US
Practice Address - Phone:910-495-7337
Practice Address - Fax:910-495-0747
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-01851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205066065OtherDOCTORS DIRECT
NC13452368OtherMULTIPLAN
NC1579838OtherCOVENTRY OF THE CAROLINAS
NC5803838OtherAETNA
NC1205066065OtherHUMANA
NC19F6YOtherBCBS OF NC
NC299990OtherMEDCOST
NC1205066065OtherHEALTHNET FEDERAL SERVICES
NC4632587OtherCOVENTRY NATIONAL - COVENTRY PPO
NC1796829OtherCIGNA GREATWEST
NC1579838OtherWELLPATH
NCFH1101910OtherFIRST CAROLINA CARE
NC1205066065Medicaid
NC5680064OtherUNITED HEALTHCARE