Provider Demographics
NPI:1053300608
Name:GURUPRASAD, HEMALATHA (MD)
Entity Type:Individual
Prefix:
First Name:HEMALATHA
Middle Name:
Last Name:GURUPRASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:CHOP CARE NETWORK AT GRANDVIEW HOSPITAL
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4476
Practice Address - Fax:215-453-4738
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061687L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016571360007Medicaid
G61455Medicare UPIN
000757LYDMedicare ID - Type Unspecified