Provider Demographics
NPI:1013161082
Name:BIRTHI, PRAVARDHAN RAJASHEKAR (MD)
Entity type:Individual
Prefix:
First Name:PRAVARDHAN
Middle Name:RAJASHEKAR
Last Name:BIRTHI
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 1:403 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9728
Mailing Address - Country:US
Mailing Address - Phone:308-675-3222
Mailing Address - Fax:308-675-3234
Practice Address - Street 1:403 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9728
Practice Address - Country:US
Practice Address - Phone:308-675-3222
Practice Address - Fax:308-675-3234
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27075208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR1916OtherKENTUCKY LICENCE