Provider Demographics
NPI:1063518793
Name:PRASANNA, SWARNALATHA (MD)
Entity type:Individual
Prefix:DR
First Name:SWARNALATHA
Middle Name:
Last Name:PRASANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 PRINCE WILLIAM PKWY STE 101A
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5404
Mailing Address - Country:US
Mailing Address - Phone:703-492-0500
Mailing Address - Fax:703-497-0806
Practice Address - Street 1:4893 PRINCE WILLIAM PKWY STE 101A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5404
Practice Address - Country:US
Practice Address - Phone:703-492-0500
Practice Address - Fax:703-497-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012322162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W160S01Medicare PIN
VAI22864Medicare UPIN