Provider Demographics
NPI:1154313062
Name:PRADA, GARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:PRADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:410-740-2900
Practice Address - Fax:410-740-2955
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0022587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1342957OtherCIGNA PIN
MD243371OtherMAMSI SPECIALIST
MD443211800Medicaid
MD3509-0005OtherCAREFIRST BLUECHOICE
MD4238655OtherAETNA FEE FOR SERVICE
MD024210OtherJHHC PROVIDER NUMBER
MD0477640OtherAETNA CAPITATED
MD843371OtherMAMSI PRIMARY CARE
MD110140826OtherRR MEDICARE
MD524039-01OtherCAREFIRST MD RENDERING
MDP12723OtherCAREFIRST MPOS
MD4238655OtherAETNA FEE FOR SERVICE
MD1342957OtherCIGNA PIN