Individual
PRASAD S MATURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1040 DELAWARE AVENUE, MARION, OH 43301-1814
(740) 383-7920
(740) 383-7942
Mailing address
# L-3652, COLUMBUS, OH 43260-6453
(740) 383-7927
(740) 383-7942
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35053451M
OH
207RG0100X
Gastroenterology Physician
Primary
35053451M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000118385
ANTHEM
OH
05
—
0633470
—
OH
01
—
100004717
TRAVELERS MEDICARE
—
01
—
2900073
UHC
—
01
—
311098079
PPO NEXT
—
01
—
311098079037
CIGNA
—
01
—
643272
AETNA
—
Enumeration date
06/09/2006
Last updated
10/23/2015
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