Provider Demographics
NPI:1912042276
Name:PRASAD, RAVI SHANKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:SHANKAR
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 4313
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4313
Mailing Address - Country:US
Mailing Address - Phone:805-375-8800
Mailing Address - Fax:805-375-8900
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:M-335
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238964-12085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA102976OtherSTATE LICENSE NUMBER
CAA102976OtherSTATE LICENSE NUMBER