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General NPI Number Information
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NPI Number | 1265840276
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Entity Type | Individual
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Provider Name | PRASAD KRISHNAKURUP M.D
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 169 MARTIN AVE
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City | EPHRATA
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State | PA
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Zip | 17522-1734
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Country | US
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Telephone | 717-738-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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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 | MT207150
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 282461
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD471455
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License Number State | PA
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