Healthcare Provider Details

I. General information

NPI: 1942696471
Provider Name (Legal Business Name): PRANAY PRABHAKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

IV. Provider business mailing address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-02708
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number291659
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2026-02708
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number291659
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: