Provider Demographics
NPI:1841385564
Name:HORNELL INTERNAL MEDICINE & NEPHROLOGY, PC
Entity Type:Organization
Organization Name:HORNELL INTERNAL MEDICINE & NEPHROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAVIDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARIPRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-324-3794
Mailing Address - Street 1:343 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1033
Mailing Address - Country:US
Mailing Address - Phone:607-324-3794
Mailing Address - Fax:607-324-3795
Practice Address - Street 1:343 SENECA RD
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1033
Practice Address - Country:US
Practice Address - Phone:607-324-3794
Practice Address - Fax:607-324-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127174207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00460031Medicaid
NYBT9Medicaid
NYBT9Medicaid