Provider Demographics
NPI:1164447306
Name:PRASANNA, HARINI SANKHAVARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HARINI
Middle Name:SANKHAVARAM
Last Name:PRASANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HOSPITAL DR
Mailing Address - Street 2:204
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5860
Mailing Address - Country:US
Mailing Address - Phone:410-768-8525
Mailing Address - Fax:410-768-9757
Practice Address - Street 1:325 HOSPITAL DR
Practice Address - Street 2:204
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5860
Practice Address - Country:US
Practice Address - Phone:410-768-8525
Practice Address - Fax:410-768-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF05405Medicare UPIN