Healthcare Provider Details

I. General information

NPI: 1518086115
Provider Name (Legal Business Name): PRASHANTI RAJAGOPALAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 EAST BRANNON ROAD
NICHOLASVILLE KY
40356
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 202
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-5540
  • Fax: 859-260-5545
Mailing address:
  • Phone: 859-260-4385
  • Fax: 859-260-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03216
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOS012445
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: