Provider Demographics
NPI:1295797629
Name:HOSUR, SRIKANTH (MD)
Entity type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:
Last Name:HOSUR
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:2350 FREEDOM WAY STE 202
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8202
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2116207R00000X, 207RC0200X
RI11755207R00000X
MN49748207RC0200X
PAMD450951207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204104803Medicaid
TX204104804Medicaid
RI7057747Medicaid
MN694175000Medicaid
TXTXB148416Medicare PIN
TX204104803Medicaid
MN694175000Medicaid
MN810000168Medicare PIN
RI007057747Medicare ID - Type Unspecified
RI7057747Medicaid