Provider Demographics
NPI:1184736282
Name:KRISHNAPRASAD, HIREMAGALUR N (MD)
Entity type:Individual
Prefix:
First Name:HIREMAGALUR
Middle Name:N
Last Name:KRISHNAPRASAD
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 1717
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1717
Mailing Address - Country:US
Mailing Address - Phone:919-587-3115
Mailing Address - Fax:919-736-0822
Practice Address - Street 1:2811 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1647
Practice Address - Country:US
Practice Address - Phone:919-734-1141
Practice Address - Fax:919-734-3509
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23724208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00162825Medicaid
NC00162825Medicaid
NCNCC130C430Medicare PIN