Healthcare Provider Details

I. General information

NPI: 1285630921
Provider Name (Legal Business Name): PRABAAL B DEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11921 ROCKVILLE PIKE STE 505
ROCKVILLE MD
20852-2737
US

IV. Provider business mailing address

11921 ROCKVILLE PIKE STE 505
ROCKVILLE MD
20852-2737
US

V. Phone/Fax

Practice location:
  • Phone: 410-265-7300
  • Fax: 410-265-9533
Mailing address:
  • Phone: 301-881-7246
  • Fax: 301-881-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0052943
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: