Provider Demographics
NPI:1255392460
Name:HARIPRASAD, MAVIDI K (MD)
Entity type:Individual
Prefix:DR
First Name:MAVIDI
Middle Name:K
Last Name:HARIPRASAD
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 1:343 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1033
Mailing Address - Country:US
Mailing Address - Phone:607-324-3794
Mailing Address - Fax:607-324-3795
Practice Address - Street 1:343 SENECA RD
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1033
Practice Address - Country:US
Practice Address - Phone:607-324-3794
Practice Address - Fax:607-324-3795
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127174207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00460031Medicaid
NY00460031Medicaid
NY37709BMedicare ID - Type Unspecified