Healthcare Provider Details

I. General information

NPI: 1467694596
Provider Name (Legal Business Name): SURY M PUTCHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MAIN ST
ENDICOTT NY
13760-4816
US

IV. Provider business mailing address

201 E MAIN ST
ENDICOTT NY
13760-4816
US

V. Phone/Fax

Practice location:
  • Phone: 607-785-2050
  • Fax: 607-785-2034
Mailing address:
  • Phone: 607-785-2050
  • Fax: 607-785-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number100032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: