Provider Demographics
NPI:1770542276
Name:NAGABHUSHANA, GURUMURTHAIAH V (MD)
Entity type:Individual
Prefix:DR
First Name:GURUMURTHAIAH
Middle Name:V
Last Name:NAGABHUSHANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G
Other - Middle Name:V
Other - Last Name:NAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:470 CANISTEO ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843
Mailing Address - Country:US
Mailing Address - Phone:607-324-4414
Mailing Address - Fax:607-324-6072
Practice Address - Street 1:470 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843
Practice Address - Country:US
Practice Address - Phone:607-324-4414
Practice Address - Fax:607-324-6072
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1261591208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00484313Medicaid
NY00484313Medicaid
NY39717BMedicare UPIN