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General NPI Number Information
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NPI Number | 1326008582
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Entity Type | Individual
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Provider Name | PRAFULL K DAVE MD PA
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 188 THOMAS JOHNSON DRIVE SUITE 200
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City | FREDERICK
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State | MD
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Zip | 21702
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Country | US
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Telephone | 301-898-3010
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Fax | 301-695-5485
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Provider Business Mailing Address
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Address Line | 188 THOMAS JOHNSON DR STE 200
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City | FREDERICK
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State | MD
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Zip | 21702-5181
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Country | US
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Telephone | 301-898-3010
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Fax | 301-695-5485
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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 | D0020922
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License Number State | MD
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