Provider Demographics
NPI:1861255903
Name:KORAH, PRATHIBHA (APRN)
Entity type:Individual
Prefix:
First Name:PRATHIBHA
Middle Name:
Last Name:KORAH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 BRIAR SPG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2059
Mailing Address - Country:US
Mailing Address - Phone:973-641-7432
Mailing Address - Fax:
Practice Address - Street 1:1627 BRIAR SPG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2059
Practice Address - Country:US
Practice Address - Phone:973-641-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine