Provider Demographics
NPI:1962685206
Name:KURUP, PRIYESH (MD)
Entity Type:Individual
Prefix:
First Name:PRIYESH
Middle Name:
Last Name:KURUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:301-877-5566
Mailing Address - Fax:
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-877-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435153207R00000X, 208M00000X
MDD0077779208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA212149OtherJOHNS HOPKINS
PA102200611Medicaid
PA9176196OtherAETNA
MD033824900Medicaid
PA120274OtherGEISINGER HEALTH PLAN
PA2065937OtherHIGHMARK BLUE SHIELD
PA120274OtherGEISINGER HEALTH PLAN
PA2065937OtherHIGHMARK BLUE SHIELD
PA132251EZ3Medicare PIN
PA250029OtherUNISON-WMG
PA1573490OtherGATEWAY-WMG
132251FLTMedicare PIN
PA9176196OtherAETNA
PAP00663253Medicare PIN
PA212149OtherJOHNS HOPKINS