Provider Demographics
NPI:1770681660
Name:PRASAD, KAMLA K (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMLA
Middle Name:K
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:PO BOX 37090
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3090
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-295-9369
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3129
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051333207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4526-2564OtherCARE FIRST
WV1068356OtherWORKMAN'S COMPENSATION
VA493817OtherNCPPO
VA292878OtherAMERIGROUP
VA091770OtherANTHEM
VA1770681660Medicaid
VAK142-0001OtherCARE FIRST 2005
VA292878OtherAMERIGROUP
DC527206F89Medicare ID - Type Unspecified
VA007955F81Medicare ID - Type Unspecified
VAE87332Medicare UPIN