Provider Demographics
NPI:1982698445
Name:PRAKASH, RAVI (MD, FAAP DABP MRCP)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD, FAAP DABP MRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4106
Mailing Address - Country:US
Mailing Address - Phone:860-886-0202
Mailing Address - Fax:860-886-5068
Practice Address - Street 1:80 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4106
Practice Address - Country:US
Practice Address - Phone:860-886-0202
Practice Address - Fax:860-886-5068
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-10-22
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CT035836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2453549OtherAETNA
CT001358367Medicaid
CT00135836703OtherBLUECARE FAMILY PLAN
CT0V8084OtherHEALTHNET
CT1241197OtherUNITED HEALTHCARE
CT4682678002OtherCIGNA
CTP2061637OtherOXFORD
CT010035836CT02OtherANTHEM BLUE CROSS
CT744319OtherCONNECTICARE