Prasad Srinivasan, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

022206 Issued in CT

Practice address

622 Hebron Ave Ste 104B
Glastonbury, CT 06033-5003

Phone

(860) 659-8904

Fax

(860) 246-5828

NPI assigned

Feb 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: srinivasan.prasad.021.0090427@avh.meditab.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prospect Manchester Hospital, Inc.

  • Health Educator
  • South Windsor, CT
  • NPI 1821695222
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1740253517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 HEBRON AVE STE 104B",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060335003",
            "telephone_number": "860-659-8904",
            "fax_number": "860-246-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 HEBRON AVE STE 104B",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060335003",
            "telephone_number": "860-659-8904",
            "fax_number": "860-246-5828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Woodland St",
            "address_2": "Suite 11",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061052372",
            "country_code": "US",
            "telephone_number": "860-246-7273",
            "fax_number": "860-246-5828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21 Woodland St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061054318",
            "country_code": "US",
            "telephone_number": "860-246-7273",
            "fax_number": "860-246-5828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SRINIVASAN",
        "first_name": "PRASAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "CT",
            "license": "022206",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "CT",
            "license": "022206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "030000070",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001222066",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C00280",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Kendall Spiewak, REGISTERED DIETITIAN
• Ernest B Spira, DDS
• Katherine Spring
• Ernest Luke Squatrito, D.O.
• Mullai Srinivasan, BCBA
• Richard Stachelek, RPH
• Dorothy C Standish, LPC
• Ioana Cristiana Stanescu, MD
• Brittney Stanley
• Starling Physicians, PLLC

• Allergy & Immunology Physician in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Allergy & Immunology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.