Provider Demographics
NPI:1851405369
Name:GIRI, SHANKAR PRAHARAJU GIRIJA (MD)
Entity Type:Individual
Prefix:
First Name:SHANKAR
Middle Name:PRAHARAJU GIRIJA
Last Name:GIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G. SHANKAR
Other - Middle Name:
Other - Last Name:GIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:UNIVERSITY OF MISSISSIPPI MEDICAL CENTER -RADIATION ONC
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4505
Mailing Address - Country:US
Mailing Address - Phone:601-815-7652
Mailing Address - Fax:601-815-6876
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:UNIVERSITY OF MS MEDICAL CENTER-RADIATION ONCOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4505
Practice Address - Country:US
Practice Address - Phone:601-815-7652
Practice Address - Fax:601-815-6876
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010317942085R0001X
MS218342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08255715Medicaid
MS08255715Medicaid
MS302I926978Medicare PIN
VAE73816Medicare UPIN