Basic Information
| Provider Information | |||||||||
| NPI: | 1922009935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRASHER | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 ROBESON ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104844100 | ||||||||
| FaxNumber: | 9104844179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 ROBESON ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104844100 | ||||||||
| FaxNumber: | 9104844179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 200301160 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 89135R3 | 05 | NC | MEDICAID | P00074543 | 01 | NC | RAIL ROAD MEDICARE | OTHER |