Healthcare Provider Details

I. General information

NPI: 1336108216
Provider Name (Legal Business Name): PRATAP KUMAR SOURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR SUITE 201
BARNESVILLE OH
43713-1098
US

IV. Provider business mailing address

100 HOSPITAL DR SUITE 201
BARNESVILLE OH
43713-1098
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-5150
  • Fax: 740-425-5152
Mailing address:
  • Phone: 740-425-5150
  • Fax: 740-425-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36645
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: