1710971585 NPI number — SUDHIR PRASADA MD

Table of content: SUDHIR PRASADA MD (NPI 1710971585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710971585 NPI number — SUDHIR PRASADA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRASADA
Provider First Name:
SUDHIR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710971585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-937-0200
Provider Business Mailing Address Fax Number:
252-451-0056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N WINSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-8467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-937-0229
Provider Business Practice Location Address Fax Number:
252-937-3109
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  36803 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 69028 . This is a "BCBSNC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 69976 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 60027798 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 7969028 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9782566 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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