Healthcare Provider Details

I. General information

NPI: 1548286743
Provider Name (Legal Business Name): SHANKAR KURRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARYS AVE
KINGSTON NY
12401-5829
US

IV. Provider business mailing address

105 MARYS AVE
KINGSTON NY
12401-5829
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-2500
  • Fax: 845-334-3070
Mailing address:
  • Phone: 845-338-2500
  • Fax: 845-334-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-092212
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number334665
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number35-092212
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01047100
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-092212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: