Provider Demographics
NPI:1811965734
Name:PRAKASH, MADHAVI RATNAM (MD PHD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:RATNAM
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:15 PARKMAN STREET
Mailing Address - Street 2:WACC 812, DEPARTMENT OF PSYCHIATRY, MGH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-2000
Mailing Address - Fax:617-726-7541
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WACC 812, DEPARTMENT OF PSYCHIATRY, MGH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:617-726-7541
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-12-19
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1557032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0187887Medicaid
MAA28629Medicare ID - Type Unspecified
G74497Medicare UPIN