Provider Demographics
NPI:1861490377
Name:PRASAD, INDRA DEO (MD)
Entity Type:Individual
Prefix:DR
First Name:INDRA
Middle Name:DEO
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 1:85 S HARRISON ST
Mailing Address - Street 2:203
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1700
Mailing Address - Country:US
Mailing Address - Phone:973-395-1020
Mailing Address - Fax:973-395-1030
Practice Address - Street 1:85 S HARRISON ST
Practice Address - Street 2:203
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1700
Practice Address - Country:US
Practice Address - Phone:973-395-1020
Practice Address - Fax:973-395-1030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06733900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist