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General NPI Number Information
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NPI Number | 1154313062
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Entity Type | Individual
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Provider Name | GARY C. PRADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 11055 LITTLE PATUXENT PKWY SUITE 104
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City | COLUMBIA
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State | MD
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Zip | 21044-2896
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Country | US
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Telephone | 410-740-2900
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Fax | 410-740-2955
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Provider Business Mailing Address
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Address Line | 1111 BENFIELD BLVD SUITE 200
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City | MILLERSVILLE
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State | MD
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Zip | 21108-3002
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Country | US
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Telephone | 410-729-5100
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Fax | 410-729-5156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0022587
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License Number State | MD
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