Provider Demographics
NPI:1902197825
Name:ALLADA, PRASANNA KUMAR (MBBS, MPH, MD)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:KUMAR
Last Name:ALLADA
Suffix:
Gender:M
Credentials:MBBS, MPH, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2120 SPRINGHOUSE RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1869
Mailing Address - Country:US
Mailing Address - Phone:256-701-1435
Mailing Address - Fax:
Practice Address - Street 1:1010 AIRPORT RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1477
Practice Address - Country:US
Practice Address - Phone:256-701-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL33509207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program