Healthcare Provider Details

I. General information

NPI: 1235367301
Provider Name (Legal Business Name): PREMIERE HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 TOWER OAKS BLVD SUITE 100
NORTH BETHESDA MD
20852-4216
US

IV. Provider business mailing address

3200 TOWER OAKS BLVD SUITE 100
NORTH BETHESDA MD
20852-4216
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-1711
  • Fax: 301-770-1624
Mailing address:
  • Phone: 301-770-1711
  • Fax: 301-770-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0055302
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberD0055302
License Number StateMD

VIII. Authorized Official

Name: DR. SANJAY PRASAD
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-770-1711