Provider Demographics
NPI:1124276290
Name:KESHAVA PRASAD, RANGACHAR (MD)
Entity type:Individual
Prefix:DR
First Name:RANGACHAR
Middle Name:
Last Name:KESHAVA PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 RELIANT RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-6501
Mailing Address - Country:US
Mailing Address - Phone:860-524-9290
Mailing Address - Fax:
Practice Address - Street 1:4578 RELIANT RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-6501
Practice Address - Country:US
Practice Address - Phone:860-524-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35978207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine