Provider Demographics
NPI:1821034141
Name:PRASAD, PREMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PREMA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2104
Mailing Address - Country:US
Mailing Address - Phone:973-891-1321
Mailing Address - Fax:
Practice Address - Street 1:3175 ROUTE 10
Practice Address - Street 2:SUITE 500
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3491
Practice Address - Country:US
Practice Address - Phone:973-537-1400
Practice Address - Fax:973-366-1648
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06191400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5917459OtherAETNA
NJ1786357OtherPHCS
NJ0857907000OtherAMERIHEALTH
NJ200442873OtherGREATHEALTH
NJ200442873OtherHEALTHNET
NJ7163304Medicaid
NJP679666OtherOXFORD
NJ200442873OtherCIGNA
NJ200442873OtherBLUECROSS/BLUESHIELD
NJ200442873OtherFIRSTHEALTH
NJ200442873OtherQUALCARE
NJ200442873OtherUNITEDHEALTH
NJ200442873OtherQUALCARE
NJPR826827Medicare ID - Type Unspecified