Provider Demographics
NPI:1083828685
Name:SANTHANAM, PRASANNA (MD)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:
Last Name:SANTHANAM
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 1:601 N CAROLINE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0006
Mailing Address - Country:US
Mailing Address - Phone:410-955-6989
Mailing Address - Fax:443-287-2933
Practice Address - Street 1:601 N CAROLINE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-6989
Practice Address - Fax:443-287-2933
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080953207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100118410Medicaid
KYP400026387Medicare PIN
OH4303671Medicare PIN
WV3810017592Medicaid
OH3046591Medicaid