Provider Demographics
NPI:1871584318
Name:MAHALINGASHETTY, PRAKASH G (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:G
Last Name:MAHALINGASHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-1129
Mailing Address - Fax:606-237-0331
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-1129
Practice Address - Fax:606-237-0331
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20904208600000X
WV19423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209042Medicaid
WV0125873-000Medicaid
WV0125873-000Medicaid
KY64209042Medicaid
WVMA4044852Medicare ID - Type Unspecified