Provider Demographics
NPI:1952375024
Name:JOSHI, PRASHANT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:
Last Name:JOSHI
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 1:4800 ALBERTA AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2709
Mailing Address - Country:US
Mailing Address - Phone:915-215-4879
Mailing Address - Fax:915-545-6975
Practice Address - Street 1:4845 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR00352080P0203X, 2080P0203X
NY2089472080P0203X, 2080T0002X
PAMD4302062080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1210079OtherIHA
000524976004OtherBC/BS
00010314402OtherUNIVERA
000524976005OtherBC/BS
040426001459OtherFIDELIS
PA0016936150001Medicaid
NY01789679Medicaid
BB1457Medicare PIN
040426001459OtherFIDELIS