Basic Information
| Provider Information | |||||||||
| NPI: | 1699919878 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ACHARYA | ||||||||
| FirstName: | PRASAD | ||||||||
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| Credential: | MD, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14613 POMMEL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028304139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3110 KERNER BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949015411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154481500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | D0080949 | MD | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | A155413 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.