Healthcare Provider Details

I. General information

NPI: 1639687031
Provider Name (Legal Business Name): PRASHANTH R PILLAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

1900 RESTON METRO PLZ STE 600
RESTON VA
20190-5952
US

V. Phone/Fax

Practice location:
  • Phone: 209-936-9818
  • Fax:
Mailing address:
  • Phone: 866-246-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101273604
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA193217
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-24069
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101273604
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-24069
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA193217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: