Provider Demographics
NPI:1366447286
Name:PRASAD, YOGENDRA (MD)
Entity Type:Individual
Prefix:
First Name:YOGENDRA
Middle Name:
Last Name:PRASAD
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6061
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST STE 230
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2868
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-324-4941
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092635207RC0000X
KY38557207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821290Medicaid
KY000000560565OtherANTHEM BCBS
KY000000598144OtherANTHEM BCBS
KY000000598313OtherANTHEM BCBS
KY000000609830OtherANTHEM BCBS
KY64081102Medicaid
KY000000598144OtherANTHEM BCBS
KY0642925Medicare PIN
OH2821290Medicaid
KY64081102Medicaid
KY0631731Medicare PIN
KY00879001Medicare PIN
KYP00682939Medicare PIN
KY00903001Medicare PIN
KY00422003Medicare PIN