Provider Demographics
NPI:1053334771
Name:PRASAD, BALASA L (MD)
Entity Type:Individual
Prefix:DR
First Name:BALASA
Middle Name:L
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12 N 7TH AVE
Mailing Address - Street 2:ANESTHESIA DEPT - 4TH FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2026
Mailing Address - Country:US
Mailing Address - Phone:914-667-8136
Mailing Address - Fax:914-667-8136
Practice Address - Street 1:12 N 7TH AVE
Practice Address - Street 2:ANESTHESIA DEPT - 4TH FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2026
Practice Address - Country:US
Practice Address - Phone:914-667-8136
Practice Address - Fax:914-667-8136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY121735207L00000X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00228666Medicaid
NYC11324Medicare UPIN