Provider Demographics
NPI:1710971585
Name:PRASADA, SUDHIR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHIR
Middle Name:
Last Name:PRASADA
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 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0229
Practice Address - Fax:252-937-3109
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36803207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND69028OtherBCBSNC
NC69976OtherMEDCOST
ND60027798OtherRAILROAD MEDICARE
NC7969028Medicaid
NC9782566OtherCIGNA HEALTHCARE
ND69028OtherBCBSNC
NC7969028Medicaid