Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 036125648 | IL |
N | 2088P0231X | Pediatric Urologist | 036125648 | IL |
Y | 2088P0231X | Pediatric Urologist | 34633 | SC |
NPI | 1003976853 |
---|---|
Provider Name | Michaella Maloney Prasad |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 15/08/2012 |