Provider Demographics
NPI:1538192604
Name:PRAKASH, HEMANT (MD)
Entity type:Individual
Prefix:
First Name:HEMANT
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 VINEHAVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-784-1010
Mailing Address - Fax:704-784-1013
Practice Address - Street 1:1040 VINEHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-784-1010
Practice Address - Fax:704-784-1013
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC043591082OtherCOMMERCIALS
NC68989OtherBCBS
NC8968989Medicaid
NC68989OtherBCBS