MEDICARE: GOVARDHAN SONTHINENI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	137010	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790773984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOVARDHAN SONTHINENI MD

Provider Business Mailing Address
First Line	:	38 FRONT ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-4712
Country	:	US
Telephone Number	:	607-772-9556
Fax Number	:	607-772-9558

Provider Business Practice Location Address
First Line	:	38 FRONT ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-4712
Country	:	US
Telephone Number	:	607-772-9556
Fax Number	:	607-772-9558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	10/14/2010

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