Healthcare Provider Details

I. General information

NPI: 1013356120
Provider Name (Legal Business Name): KAPIL PRUTHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 FISHER RD
MECHANICSBURG PA
17055-5122
US

IV. Provider business mailing address

2140 FISHER RD
MECHANICSBURG PA
17055-5122
US

V. Phone/Fax

Practice location:
  • Phone: 717-766-1795
  • Fax: 717-697-6575
Mailing address:
  • Phone: 717-766-1795
  • Fax: 717-697-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS018352
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: