Provider Demographics
NPI:1235367301
Name:PREMIERE HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:PREMIERE HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-1711
Mailing Address - Street 1:3200 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4216
Mailing Address - Country:US
Mailing Address - Phone:301-770-1711
Mailing Address - Fax:301-770-1624
Practice Address - Street 1:3200 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4216
Practice Address - Country:US
Practice Address - Phone:301-770-1711
Practice Address - Fax:301-770-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055302207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD660309200Medicaid
DC4409810Medicaid
VA5702801Medicaid
DC4409810Medicaid