Healthcare Provider Details

I. General information

NPI: 1821324963
Provider Name (Legal Business Name): PRANATHI LINGAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2009
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 E 15TH ST
EDMOND OK
73013-5029
US

IV. Provider business mailing address

14024 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1006
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8823
  • Fax:
Mailing address:
  • Phone: 405-419-8465
  • Fax: 405-419-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberP6859
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10034494
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37247
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37247
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: