Healthcare Provider Details

I. General information

NPI: 1871525543
Provider Name (Legal Business Name): PRASAD NANJAPPA BETADPUR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HEALTH CAMPUS DR
HARRISONBURG VA
22801-8679
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5600
  • Fax: 540-564-5601
Mailing address:
  • Phone: 540-564-7084
  • Fax: 540-564-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101230375
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101230375
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101230375
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: