MEDICARE: DR. SHANTI 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	174400000X	Specialist	0101227771	VA
2	207R00000X	Internal Medicine Physician	0101227771	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982646113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTI PRASAD M.D.

Provider Business Mailing Address
First Line	:	2001 COLUMBIA PIKE
Second Line	:	SUITE 131
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4547
Country	:	US
Telephone Number	:	703-979-1777
Fax Number	:	703-979-8258

Provider Business Practice Location Address
First Line	:	2001 COLUMBIA PIKE
Second Line	:	SUITE 131
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4547
Country	:	US
Telephone Number	:	703-979-1777
Fax Number	:	703-979-8258

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/17/2012

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