MEDICARE: SANJAY PRASAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	036176815	IL
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	036176815	IL
3	207YX0901X	Otology & Neurotology Physician	D43688	MD

General Provider Information

NPI Number	:	1437232139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY PRASAD M.D.

Provider Business Mailing Address
First Line	:	10215 FERNWOOD RD
Second Line	:	SUITE 301
City	:	BETHESDA
State	:	MD
Zip	:	20817-1106
Country	:	US
Telephone Number	:	301-493-9409
Fax Number	:	301-493-9429

Provider Business Practice Location Address
First Line	:	1253 N ALPINE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-2201
Country	:	US
Telephone Number	:	779-696-9201
Fax Number	:	815-397-9667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/23/2026

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