Provider Demographics
NPI:1649262445
Name:R PRASAD DEGALA MD PC
Entity type:Organization
Organization Name:R PRASAD DEGALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAMOHANA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:DEGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-535-2422
Mailing Address - Street 1:105 W BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4800
Mailing Address - Country:US
Mailing Address - Phone:252-535-2422
Mailing Address - Fax:252-535-1523
Practice Address - Street 1:105 W BECKER DR
Practice Address - Street 2:P.O DRAWER 1520
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4800
Practice Address - Country:US
Practice Address - Phone:252-535-2422
Practice Address - Fax:252-535-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC307992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417152687OtherNPI# DR.RAMAMOHANA DEGALA
NC8928184Medicaid
NC8928184Medicaid
E10260Medicare UPIN
NC230791Medicare ID - Type UnspecifiedGROUP