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Individual

RAGHURAM PRASAD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-7555
Mailing address
100 E PENN SQ, 6TH FLOOR WANAMAKER BUILDING, PHILADELPHIA, PA 19107-3323
(215) 590-6267

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036-116935
IL
2084P0800X
Psychiatry Physician
2007015932
MO
2084P0804X
Child & Adolescent Psychiatry Physician
2007015932
MO
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD443889
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036-116935
PHYSICIAN LICENSE
IL
05
036116935
IL
01
732001
BLUE CROSS BLUE SHIELD
IA
Enumeration date
06/05/2007
Last updated
01/09/2017
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