Provider Demographics
NPI:1285630921
Name:DEY, PRABAAL B (MD)
Entity type:Individual
Prefix:DR
First Name:PRABAAL
Middle Name:B
Last Name:DEY
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 1:11921 ROCKVILLE PIKE
Mailing Address - Street 2:STE 505
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2737
Mailing Address - Country:US
Mailing Address - Phone:301-881-7246
Mailing Address - Fax:301-881-2449
Practice Address - Street 1:11921 ROCKVILLE PIKE
Practice Address - Street 2:STE 505
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2737
Practice Address - Country:US
Practice Address - Phone:410-265-7300
Practice Address - Fax:410-265-9533
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052943208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD54869003OtherBLUE CROSS
MDF220-0005OtherBLUE CROSS REGIONAL
MD165P386GMedicare PIN
MDG60810Medicare UPIN
DC000905C27Medicare ID - Type UnspecifiedMEDICARE
DCG02677D09Medicare PIN
MD658L268DMedicare ID - Type UnspecifiedMEDICARE