Basic Information
| Provider Information | |||||||||
| NPI: | 1013356120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRUTHI | ||||||||
| FirstName: | KAPIL | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2140 FISHER RD | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170555122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177661795 | ||||||||
| FaxNumber: | 7176976575 | ||||||||
| Practice Location | |||||||||
| Address1: | 2140 FISHER RD | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170555122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177661795 | ||||||||
| FaxNumber: | 7176976575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS018352 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.