Provider Demographics
NPI:1164443750
Name:GULUR, PRASANNA VENKATESWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:VENKATESWAR
Last Name:GULUR
Suffix:
Gender:M
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:603-308-1467
Mailing Address - Fax:
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-578-9363
Practice Address - Fax:603-578-9539
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222814207R00000X
IN01058582A207R00000X
NH12459207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205255Medicaid
NHRE8311Medicare PIN
I33483Medicare UPIN