MEDICARE: PRAKASH R NANCHERLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G7697	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01258507	OTHER	TX	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASH R NANCHERLA MD

Provider Business Mailing Address
First Line	:	7142 SAN PEDRO AVE
Second Line	:	SUITE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6254
Country	:	US
Telephone Number	:	210-661-5622
Fax Number	:	210-395-4012

Provider Business Practice Location Address
First Line	:	102 PALO ALTO RD
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-3758
Country	:	US
Telephone Number	:	210-403-0765
Fax Number	:	210-547-9270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/13/2015

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Directions to “ PRAKASH R NANCHERLA MD” Practice Location

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