Basic Information
| Provider Information | |||||||||
| NPI: | 1003839986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRASAD | ||||||||
| FirstName: | ANUJ | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103874520 | ||||||||
| FaxNumber: | 6103874526 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MARIS GROVE WAY | ||||||||
| Address2: | |||||||||
| City: | GLEN MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193421282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103874520 | ||||||||
| FaxNumber: | 6103874526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS013432 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1166441 | 01 | AETNA | OTHER | 1790138 | 01 | BL SHIELD | OTHER | 2627386000 | 01 | KEYSTONE | OTHER |