Provider Demographics
NPI:1447417092
Name:GERRISH, PRIANKA KAPUR (MD)
Entity Type:Individual
Prefix:
First Name:PRIANKA
Middle Name:KAPUR
Last Name:GERRISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRIANKA
Other - Middle Name:
Other - Last Name:KAPUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2605 W SWANN AVE STE 600
Mailing Address - Street 2:LOCICERO MEDICAL GROUP
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4044
Mailing Address - Country:US
Mailing Address - Phone:813-876-7073
Mailing Address - Fax:
Practice Address - Street 1:2605 W SWANN AVE STE 600
Practice Address - Street 2:LOCICERO MEDICAL GROUP
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4044
Practice Address - Country:US
Practice Address - Phone:813-876-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238913207K00000X
FLME 103787207K00000X
LAMD.200472207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA400ZMedicare PIN