Provider Demographics
NPI:1588624498
Name:KOSURI, RAMAKRISHNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAKRISHNA
Middle Name:R
Last Name:KOSURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-665-4950
Mailing Address - Fax:301-665-4956
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-665-4950
Practice Address - Fax:301-665-4956
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00590842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21017Medicare UPIN
MD6987970015Medicare NSC
PA0449950002Medicare NSC
MD0449950001Medicare NSC