Provider Demographics
NPI:1225198187
Name:VADDE, PRASAD SATYASAI (MD)
Entity type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:SATYASAI
Last Name:VADDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SATYASAI
Other - Middle Name:PRASAD
Other - Last Name:VADDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 ROME AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4318
Mailing Address - Country:US
Mailing Address - Phone:718-447-7222
Mailing Address - Fax:718-447-7223
Practice Address - Street 1:50 ROME AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4318
Practice Address - Country:US
Practice Address - Phone:718-447-7222
Practice Address - Fax:718-447-7223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128793207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY717060Medicaid
NY0480459OtherEVERCARE
NY2C4145OtherTOUCHSTONE
NY2C4145OtherTOUCHSTONE
NY717060Medicaid