Healthcare Provider Details

I. General information

NPI: 1245487503
Provider Name (Legal Business Name): PRAKASH BHUSHAN KARN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N 4TH AVE
HOPEWELL VA
23860-2503
US

IV. Provider business mailing address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

V. Phone/Fax

Practice location:
  • Phone: 804-541-0700
  • Fax: 804-541-7924
Mailing address:
  • Phone: 804-861-0700
  • Fax: 804-863-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101251479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: