Provider Demographics
NPI:1811994601
Name:NANCHERLA, PRAKASH R (MD)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:R
Last Name:NANCHERLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6254
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-395-4012
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-403-0765
Practice Address - Fax:210-547-9270
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-08-13
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Provider Licenses
StateLicense IDTaxonomies
TXG7697207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123185405Medicaid
TXP01258507OtherMEDICARE RAIL ROAD
TX123185405Medicaid
TX123185405Medicaid