Healthcare Provider Details

I. General information

NPI: 1295046621
Provider Name (Legal Business Name): PHILIP MAHARAJ-PRASAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N LA CHOLLA BLVD
TUCSON AZ
85741-3529
US

IV. Provider business mailing address

6200 NORTH LACHOLLA BLVD
TUCSON AZ
85741
US

V. Phone/Fax

Practice location:
  • Phone: 520-724-9000
  • Fax:
Mailing address:
  • Phone: 520-724-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9652815-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number48027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: