Individual
PRASHANTH PALVANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1015 WALNUT ST STE 620, PHILADELPHIA, PA 19107
(215) 955-6864
(215) 955-2878
Mailing address
15 WILLOCKS CIR, SOMERSET, NJ 08873-7462
(908) 499-3346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MT215213
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2018
Last updated
05/23/2018
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