Provider Demographics
NPI:1508145830
Name:KODURU, PRASAD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:R
Last Name:KODURU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5303
Mailing Address - Country:US
Mailing Address - Phone:214-645-7000
Mailing Address - Fax:214-645-7001
Practice Address - Street 1:6000 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5303
Practice Address - Country:US
Practice Address - Phone:214-645-7000
Practice Address - Fax:214-645-7001
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPKODU1174400000X, 207SC0300X, 207ZP0007X
247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No174400000XOther Service ProvidersSpecialist
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology