Provider Demographics
NPI:1528073947
Name:PHULWANI, PRAKASH C (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:C
Last Name:PHULWANI
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 1:221 TALL TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3210
Mailing Address - Country:US
Mailing Address - Phone:814-269-3893
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038289L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1554363OtherGATEWAY
PA180294OtherUNISON
PA0009659080004Medicaid
PA50058292OtherCAPITAL BC
PA000965908006Medicaid
PA12371OtherGEISINGER
PAP00264184Medicare PIN
PA180294OtherUNISON
PA50058292OtherCAPITAL BC