Healthcare Provider Details

I. General information

NPI: 1437772043
Provider Name (Legal Business Name): VIKRAM SUMBLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date: 01/17/2022
Reactivation Date: 03/09/2022

III. Provider practice location address

100 PARK ST
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number343705-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: