Provider Demographics
NPI:1144294851
Name:PRABHAKAR, HIMA B (MD)
Entity type:Individual
Prefix:DR
First Name:HIMA
Middle Name:B
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SPRUCE STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-6079
Mailing Address - Fax:210-616-7799
Practice Address - Street 1:800 SPRUCE STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-6079
Practice Address - Fax:210-616-7799
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4421292085R0202X, 2085R0202X
TXM82592085B0100X, 2085U0001X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM8259OtherTEXAS LICENSE
TX1872640-04OtherMEDICAID - STRIC
TX8S3959OtherBCBS PROVIDER #
TX1872640-03Medicaid
TXP00692121OtherRR MEDICARE - STRG
TXP00692125OtherRR MEDICARE - STRIC
TX8L5908OtherMEDICARE - STRIC
TX1872640-05OtherMEDICAID - CSHCN
TXP00692125OtherRR MEDICARE - STRIC