Individual
GAUTHAM PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-3801
(434) 924-9333
(434) 244-7526
Mailing address
1215 LEE ST BOX 800334, CHARLOTTESVILLE, VA 22908-0816
(434) 924-9333
(434) 244-7526
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
0116037288
VA
Other
Enumeration date
06/03/2020
Last updated
07/04/2023
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