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General NPI Number Information
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NPI Number | 1851642300
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Entity Type | Individual
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Provider Name | USREESHA GOURNENI M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 100 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 740-446-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 7128 66TH ST
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City | GLENDALE
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State | NY
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Zip | 11385-7023
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 26621
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.130224
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME125057
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License Number State | FL
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