Provider Demographics
NPI:1376553156
Name:PRASAD, SRINIVASA (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASA
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 1:1400 PRESSLER ST
Mailing Address - Street 2:MD ANDERSON CANCER CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3722
Mailing Address - Country:US
Mailing Address - Phone:713-792-4487
Mailing Address - Fax:713-794-4379
Practice Address - Street 1:1400 PRESSLER ST
Practice Address - Street 2:MD ANDERSON CANCER CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3722
Practice Address - Country:US
Practice Address - Phone:713-792-4487
Practice Address - Fax:713-794-4379
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM75332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158972301OtherCIDC
TX158972302Medicaid
TX8L11239Medicare PIN
TX158972301OtherCIDC