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General NPI Number Information
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NPI Number | 1164443750
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Entity Type | Individual
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Provider Name | PRASANNA VENKATESWAR GULUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 168 KINSLEY ST LOWER LEVEL
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City | NASHUA
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State | NH
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Zip | 03060-3634
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Country | US
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Telephone | 603-578-9363
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Fax | 603-578-9539
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Provider Business Mailing Address
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Address Line | PO BOX 810
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City | HANOVER
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State | NH
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Zip | 03755-0810
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Country | US
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Telephone | 603-308-1467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 222814
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01058582A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 12459
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License Number State | NH
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