Provider Demographics
NPI:1245531151
Name:PRAKASH, RAJAN (MD MPH)
Entity type:Individual
Prefix:
First Name:RAJAN
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-584-0851
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:HOSPITALIST ML 670
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-7545
Practice Address - Fax:513-584-0851
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-098699207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075830Medicaid
OHP01245018OtherRAILROAD MEDICARE
IN201129820Medicaid
KY7100232560Medicaid
KY7100232560Medicaid