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General NPI Number Information
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NPI Number | 1104872779
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Entity Type | Individual
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Provider Name | SHAMSUDDIN C PRACHA MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 8881 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1333
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Country | US
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Telephone | 937-832-5292
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Fax | 937-832-7505
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Provider Business Mailing Address
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Address Line | PO BOX 634857
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City | CINCINNATI
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State | OH
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Zip | 45263-4857
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Country | US
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Telephone | 937-832-5292
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Fax | 937-832-7505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.078920
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License Number State | OH
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