Healthcare Provider Details

I. General information

NPI: 1063082683
Provider Name (Legal Business Name): PRASANTH KANNEGENTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N DU PONT PKWY
NEW CASTLE DE
19720-1160
US

IV. Provider business mailing address

1901 N DUPONT PKWY
NEW CASTLE DE
19720-1160
US

V. Phone/Fax

Practice location:
  • Phone: 302-255-2700
  • Fax:
Mailing address:
  • Phone: 302-255-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC7-0017654
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: