Healthcare Provider Details

I. General information

NPI: 1851345078
Provider Name (Legal Business Name): PRAGNA B SUTARIA, PHYSICIAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

PO BOX 1258
JAMESTOWN NY
14702-1258
US

V. Phone/Fax

Practice location:
  • Phone: 716-487-0141
  • Fax:
Mailing address:
  • Phone: 716-487-1124
  • Fax: 716-487-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number149275
License Number StateNY

VIII. Authorized Official

Name: PRAGNA B SUTARIA
Title or Position: MD
Credential: MD
Phone: 716-487-1124