Basic Information
Provider Information
NPI: 1275893299
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADHIKARI
FirstName: PRAJESH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 42210
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850802210
CountryCode: US
TelephoneNumber: 6026855166
FaxNumber: 6026855325
Practice Location
Address1: 350 W THOMAS RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850134409
CountryCode: US
TelephoneNumber: 6022639007
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2012
LastUpdateDate: 03/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X62729AZY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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