Provider Demographics
NPI:1174598551
Name:PRADA, DANIELA I (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:I
Last Name:PRADA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5187 MAYFIELD ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-449-1014
Mailing Address - Fax:440-449-8157
Practice Address - Street 1:5187 MAYFIELD ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-449-1014
Practice Address - Fax:440-449-8157
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35079528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2302949Medicaid
OH1174598551OtherNPI
OH1174598551OtherNPI
OHPR4060191Medicare ID - Type Unspecified