Basic Information
| Provider Information | |||||||||
| NPI: | 1720230071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURRAM | ||||||||
| FirstName: | MURALI KRISHNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417 | ||||||||
| Address2: | |||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249860417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035365030 | ||||||||
| FaxNumber: | 3045365031 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 1ST AVE RM 1025 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043997484 | ||||||||
| FaxNumber: | 3033997579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 107897 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 26623 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0149166 | 05 | OH | MEDICAID | 7100406380 | 05 | KY | MEDICAID | 3810030058 | 05 | WV | MEDICAID |