MEDICARE: PRAKASH D ADAWADKAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101044728	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	501200	OTHER	VA	NCPPO
2	1639078	OTHER	VA	CIGNA
3	451503	OTHER	VA	ANTHEM BLUE CROSS
4	878906	OTHER	VA	MAMSI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	955166	OTHER	VA	UNITED HEALTHCARE
8	B337-0001	OTHER	VA	CARE FIRST BLUE CROSS

General Provider Information

NPI Number	:	1235132317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASH D ADAWADKAR M.D.

Provider Business Mailing Address
First Line	:	4201 DALE BLVD
Second Line	:
City	:	DALE CITY
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-670-0300
Fax Number	:	703-670-6759

Provider Business Practice Location Address
First Line	:	4201 DALE BLVD
Second Line	:
City	:	DALE CITY
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-670-0300
Fax Number	:	703-670-6759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/18/2012

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