Healthcare Provider Details

I. General information

NPI: 1093152159
Provider Name (Legal Business Name): KARNA TUSHAR SURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5276
  • Fax:
Mailing address:
  • Phone: 315-464-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number294057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: