Healthcare Provider Details

I. General information

NPI: 1477991495
Provider Name (Legal Business Name): PRIMARY CARE GYN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 ESTATE LA GRANDE PRINCESS SUITE 1
CHRISTIANSTED VI
00820-5165
US

IV. Provider business mailing address

4040 ESTATE LA GRANDE PRINCESS SUITE 1
CHRISTIANSTED VI
00820-5165
US

V. Phone/Fax

Practice location:
  • Phone: 340-718-7788
  • Fax: 340-718-9130
Mailing address:
  • Phone: 340-718-7788
  • Fax: 340-718-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number621
License Number StateVI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11029P
License Number StateVI

VIII. Authorized Official

Name: DR. ARAKERE B PRASAD
Title or Position: OWNER / MANAGER
Credential: M.D.
Phone: 340-718-7788