Provider Demographics
NPI:1437222874
Name:NATARAJ, PRASAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:M
Last Name:NATARAJ
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 1:208 PLUMTREE RD
Mailing Address - Street 2:B
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-638-1999
Mailing Address - Fax:410-638-6355
Practice Address - Street 1:208 PLUMTREE RD
Practice Address - Street 2:B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-638-1999
Practice Address - Fax:410-638-6355
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046941207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD235991000Medicaid
MD189210Medicare PIN
MDF76423Medicare UPIN