Healthcare Provider Details

I. General information

NPI: 1003853698
Provider Name (Legal Business Name): RAJEEV PRASAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAJEEV PRASAD MD

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST STE 102
FOUNTAIN HILL PA
18015-1152
US

IV. Provider business mailing address

701 OSTRUM ST STE 102
FOUNTAIN HILL PA
18015-1152
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-5437
  • Fax:
Mailing address:
  • Phone: 484-658-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD064459L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: