Provider Demographics
NPI:1215499744
Name:YAMAJALA, PRASHANT (MD)
Entity type:Individual
Prefix:
First Name:PRASHANT
Middle Name:
Last Name:YAMAJALA
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 1:140 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DUNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:01827-1305
Mailing Address - Country:US
Mailing Address - Phone:978-674-9495
Mailing Address - Fax:
Practice Address - Street 1:550 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1016
Practice Address - Country:US
Practice Address - Phone:978-674-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22825207Q00000X
MA292982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine