=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457478117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SRINIVAS B RAPURI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 LEXINGTON STREET D
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40444-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-304-5157
-----------------------------------------------------
Fax | 859-304-5159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 LEXINGTON STREET #D
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40444-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-304-5157
-----------------------------------------------------
Fax | 859-304-5159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MT188156
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 43179
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------