Provider Demographics
NPI:1841549227
Name:MUTHUKRISHNAN, PRASHANTH THALANAYAR (MD)
Entity type:Individual
Prefix:
First Name:PRASHANTH
Middle Name:THALANAYAR
Last Name:MUTHUKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRASHANTH
Other - Middle Name:
Other - Last Name:THALANAYAR MUTHUKRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:527 MEDICAL PARK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9009
Mailing Address - Country:US
Mailing Address - Phone:681-342-3730
Mailing Address - Fax:
Practice Address - Street 1:527 MEDICAL PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9009
Practice Address - Country:US
Practice Address - Phone:681-342-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293615-1207R00000X
WV29698207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine