Healthcare Provider Details

I. General information

NPI: 1730188897
Provider Name (Legal Business Name): JWALA PRASAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-672-3309
  • Fax: 513-672-3323
Mailing address:
  • Phone: 513-672-3309
  • Fax: 513-672-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35047961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: