Healthcare Provider Details

I. General information

NPI: 1134144330
Provider Name (Legal Business Name): PRAKASH SESHADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 KENNETT PIKE CCHS DIABETES AND METABOLIC DISEASE CENTER
WILMINGTON DE
19807-3019
US

IV. Provider business mailing address

3506 KENNETT PIKE PMRI
WILMINGTON DE
19807-3019
US

V. Phone/Fax

Practice location:
  • Phone: 302-661-3070
  • Fax: 302-661-3080
Mailing address:
  • Phone: 302-661-3070
  • Fax: 302-661-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC10008054
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: