Healthcare Provider Details

I. General information

NPI: 1174510945
Provider Name (Legal Business Name): PRAKASH B. CHOUGULE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 TOLL GATE RD
WARWICK RI
02886-2715
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-2300
  • Fax: 401-738-3450
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD06662
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: