Provider Demographics
NPI:1336108216
Name:SOURI, PRATAP KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRATAP
Middle Name:KUMAR
Last Name:SOURI
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 1:100 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1098
Mailing Address - Country:US
Mailing Address - Phone:740-425-5150
Mailing Address - Fax:740-425-5152
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1098
Practice Address - Country:US
Practice Address - Phone:740-425-5150
Practice Address - Fax:740-425-5152
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225554Medicaid
OH0225554Medicaid
OHSO2012311Medicare PIN