Provider Demographics
NPI:1861709156
Name:AVHAD, PRAJAKTA V (MD)
Entity type:Individual
Prefix:
First Name:PRAJAKTA
Middle Name:V
Last Name:AVHAD
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 1:51 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3448
Mailing Address - Country:US
Mailing Address - Phone:732-476-8970
Mailing Address - Fax:732-846-7001
Practice Address - Street 1:51 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3448
Practice Address - Country:US
Practice Address - Phone:732-846-7000
Practice Address - Fax:732-846-7001
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257357207LP2900X
PAMD472148207LP2900X
OH095776207LP2900X
NJ25MA09001500207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0311791Medicaid
NJFA2960094OtherDEA