Provider Demographics
NPI:1760460349
Name:PRASAD, SUMAN
Entity Type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUMAN
Other - Middle Name:KUMARI
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:3521 FOREST OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7417
Mailing Address - Country:US
Mailing Address - Phone:919-636-0461
Mailing Address - Fax:919-428-2905
Practice Address - Street 1:1417 W PETTIGREW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4820
Practice Address - Country:US
Practice Address - Phone:919-286-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137P5Medicaid
NC89137P5Medicaid
NCH06613Medicare UPIN