Provider Demographics
NPI:1689877037
Name:ADUSUMILLI, PRASAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:S
Last Name:ADUSUMILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRASAD
Other - Middle Name:SATYANARAYANA
Other - Last Name:ADUSUMILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1275 YORK AVE MSKCC
Mailing Address - Street 2:C-877 DIVISION OF THORACIC SURGERY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-639-8093
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:C-877 DIVISION OF THORACIC SURGERY MSKCC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-639-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243840208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)