Provider Demographics
NPI:1356377071
Name:DIGHE, PRASAD (MD)
Entity type:Individual
Prefix:
First Name:PRASAD
Middle Name:
Last Name:DIGHE
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 1:2626 N CALIFORNIA ST
Mailing Address - Street 2:STE B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-466-2626
Mailing Address - Fax:209-466-7153
Practice Address - Street 1:2626 N CALIFORNIA ST
Practice Address - Street 2:STE B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5500
Practice Address - Country:US
Practice Address - Phone:209-466-2626
Practice Address - Fax:209-466-7153
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A368101Medicare PIN
CA6792110001Medicare NSC
CA00A368100Medicare PIN
C03955Medicare UPIN