Healthcare Provider Details

I. General information

NPI: 1922009935
Provider Name (Legal Business Name): SANJAY PRASHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST SUITE 301
FAYETTEVILLE NC
28305-5640
US

IV. Provider business mailing address

2301 ROBESON ST SUITE 301
FAYETTEVILLE NC
28305-5640
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4100
  • Fax: 910-484-4179
Mailing address:
  • Phone: 910-484-4100
  • Fax: 910-484-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number200301160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: