Provider Demographics
NPI:1992876569
Name:DARJI, PRAKASH R (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:R
Last Name:DARJI
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 1:29 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3615
Mailing Address - Country:US
Mailing Address - Phone:413-499-8510
Mailing Address - Fax:413-499-8553
Practice Address - Street 1:2906 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6006
Practice Address - Country:US
Practice Address - Phone:321-841-7856
Practice Address - Fax:407-253-2563
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230136207R00000X, 208M00000X
FLME154208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043531502OtherCIGNA INDEMNITY
MD043531502OtherGIC INDEMNITY
MA6003108OtherMVP
MAJ40995OtherBCBS
MA043531502OtherHMC PPO
MA10117498OtherCDPHP
MAAA75439OtherHARVARD PILGRIM
MA043531502OtherAETNA
MA043531502OtherUHC
MA39532OtherHEALTH NEW ENGLAND
MA5034677OtherCIGNA HMO
MA000000037261OtherHEALTHNET
MA495566OtherTUFTS
MAP00367440OtherRAILROAD MEDICARE
MAJ40995OtherBCBS
MAA40731Medicare ID - Type Unspecified