Provider Demographics
NPI:1124098868
Name:BEERAKA, PRAKASH S (MD)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:S
Last Name:BEERAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-662-1533
Mailing Address - Fax:843-679-7273
Practice Address - Street 1:101 SOUTH RAVENEL STREET
Practice Address - Street 2:SUITE 160
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2610
Practice Address - Country:US
Practice Address - Phone:843-662-1533
Practice Address - Fax:843-679-7273
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC30937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18500OtherEVOLUTIONS
SC7135571OtherAETNA
SC005OtherBLUE CHOICE
SC014OtherTRICARE
NC5909956Medicaid
SC20078271OtherSELECT HEALTH
SC210717OtherMEDCOST
SC309370Medicaid
SC2298624OtherCIGNA
SC005OtherBSBC
SC005OtherBLUECHOICE
SC246983OtherUNISON
SCAA29248552OtherMEDICARE