Provider Demographics
NPI:1649283631
Name:PRAKASH, ROHIT (MD)
Entity type:Individual
Prefix:DR
First Name:ROHIT
Middle Name:
Last Name:PRAKASH
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 1:255 DUEBER AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1111
Mailing Address - Country:US
Mailing Address - Phone:330-455-0291
Mailing Address - Fax:330-455-0750
Practice Address - Street 1:255 DUEBER AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706
Practice Address - Country:US
Practice Address - Phone:330-455-0291
Practice Address - Fax:330-455-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723195Medicaid
E54287Medicare UPIN
OH0723195Medicaid