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General NPI Number Information
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NPI Number | 1275517526
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Entity Type | Individual
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Provider Name | PRABHKAR K SHETTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 36 COUNTRY CLUB RD
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City | GILFORD
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State | NH
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Zip | 03249-6978
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Country | US
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Telephone | 603-524-8020
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Fax | 603-527-0271
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Provider Business Mailing Address
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Address Line | PO BOX 7392 VILLAGE WEST II
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City | LACONIA
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State | NH
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Zip | 03247-7392
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Country | US
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Telephone | 603-524-8020
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Fax | 603-527-0271
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 4969
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License Number State | NH
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