Provider Demographics
NPI:1972578490
Name:ATLURI, PURNA CHANDRA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNA CHANDRA PRASAD
Middle Name:
Last Name:ATLURI
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-0180
Mailing Address - Country:US
Mailing Address - Phone:718-237-1596
Mailing Address - Fax:718-222-1650
Practice Address - Street 1:481 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1889
Practice Address - Country:US
Practice Address - Phone:718-237-1596
Practice Address - Fax:718-222-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189588207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707157Medicaid
NYG20894Medicare UPIN
NY01707157Medicaid