Provider Demographics
NPI:1962488098
Name:PRASAD, CHANDRA N (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:N
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 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-556-7722
Mailing Address - Fax:573-635-1527
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-556-7722
Practice Address - Fax:573-635-1527
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107605208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113361OtherBCBS
MO000015403OtherLVC MCR GROUP
MO290992OtherHEALTHLINK
MO020037459OtherPALMETTO GBA
MO020037459OtherMEDICARE RAILROAD
MO208198119Medicaid
MOCD6061OtherRAILROAD GROUP
MOCD6061OtherRAILROAD GROUP
MO020037459OtherMEDICARE RAILROAD
MO208198119Medicaid