Provider Demographics
NPI:1194751396
Name:PRABHAKAR, RAMYA (MD)
Entity type:Individual
Prefix:
First Name:RAMYA
Middle Name:
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:275 VARNUM AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2141
Mailing Address - Country:US
Mailing Address - Phone:978-942-2064
Mailing Address - Fax:978-942-2068
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2141
Practice Address - Country:US
Practice Address - Phone:978-942-2064
Practice Address - Fax:978-942-2068
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216763207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0030060OtherNEIGHBORHOOD HEALTH
MA2009960Medicaid
MA696778OtherHARVARD PILGRIM
MA216763OtherTUFTS
MAJ26190OtherBLUE CROSS
MA216763OtherTUFTS
MAA35627Medicare ID - Type Unspecified