Provider Demographics
NPI:1053705160
Name:MAINALI, PRAJEENA (DO)
Entity type:Individual
Prefix:
First Name:PRAJEENA
Middle Name:
Last Name:MAINALI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TURNER CT
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2128
Mailing Address - Country:US
Mailing Address - Phone:703-795-6334
Mailing Address - Fax:
Practice Address - Street 1:203 PLYMOUTH AVE STE 701
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4300
Practice Address - Country:US
Practice Address - Phone:502-235-5445
Practice Address - Fax:508-235-5594
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty