Provider Demographics
NPI:1124087820
Name:PRASAD, RENUKA N (MD)
Entity type:Individual
Prefix:
First Name:RENUKA
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 1:212 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2924
Mailing Address - Country:US
Mailing Address - Phone:434-799-9020
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2924
Practice Address - Country:US
Practice Address - Phone:434-799-9020
Practice Address - Fax:434-799-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101313742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007191103Medicaid
VA011431D76Medicare PIN
VA007191103Medicaid