Healthcare Provider Details

I. General information

NPI: 1053411694
Provider Name (Legal Business Name): VINAY PRASAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C-3322 MEDICAL CTR N
NASHVILLE TN
37232-2561
US

IV. Provider business mailing address

VANDERBILT MEDICAL CTR C-3322 MEDICAL CTR N
NASHVILLE TN
37232-2561
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3234
  • Fax: 615-322-5551
Mailing address:
  • Phone: 615-322-3234
  • Fax: 615-322-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberE-4800
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number55418
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number35.090576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: