Provider Demographics
NPI:1780706820
Name:SANTHEKADUR, PRASHANTH PARAMESH (MD)
Entity type:Individual
Prefix:
First Name:PRASHANTH
Middle Name:PARAMESH
Last Name:SANTHEKADUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-2377
Mailing Address - Country:US
Mailing Address - Phone:410-884-1311
Mailing Address - Fax:410-884-6033
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:410-884-1311
Practice Address - Fax:410-884-6033
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0066350207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402077400Medicaid
MDG972OtherBLUE CHOICE , FEP
MDKES7INOtherCAREFIRST MARYLAND GROUP #
MEI26243Medicare UPIN
MD402077400Medicaid