Provider Demographics
NPI:1649688680
Name:PRASAD, SUMIT
Entity type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WOODBRIDGE CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3836
Mailing Address - Country:US
Mailing Address - Phone:410-676-6100
Mailing Address - Fax:
Practice Address - Street 1:1013 WOODBRIDGE CENTER WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3836
Practice Address - Country:US
Practice Address - Phone:410-676-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist