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1659995835
GAUTHAM PRAKASH
CHARLOTTESVILLE, VA
NPI
1659995835
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: VA 0116037288)
Enumeration Date
2020-06-03
Last Update Date
2023-07-04
Business Address
GAUTHAM PRAKASH MD
1215 LEE ST
CHARLOTTESVILLE, VA 22908-3801
Phone number: 434-924-9333
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Mailing Address
GAUTHAM PRAKASH MD
1215 LEE ST BOX 800334
CHARLOTTESVILLE, VA 22908-0816
Phone number: 434-924-9333
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