Provider Demographics
NPI:1063607059
Name:PRABHAKAR, AVANI (MBBS MPH)
Entity type:Individual
Prefix:DR
First Name:AVANI
Middle Name:
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:MBBS MPH
Other - Prefix:DR
Other - First Name:AVANI
Other - Middle Name:LAXMANDAS
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS MPH
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:600 N WOLFE STREET
Practice Address - Street 2:BLALOCK 359
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-8305
Practice Address - Fax:410-955-2098
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091512207R00000X
MDD86504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine