Provider Demographics
NPI:1124680483
Name:PURMESSUR, PRAVISH (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVISH
Middle Name:
Last Name:PURMESSUR
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 1:1770 GRAND CONCOURSE APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5526
Mailing Address - Country:US
Mailing Address - Phone:929-215-8751
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 5A43
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-7697
Practice Address - Country:US
Practice Address - Phone:302-623-0386
Practice Address - Fax:302-733-5640
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0024920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine