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General NPI Number Information
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NPI Number | 1265631899
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Entity Type | Individual
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Provider Name | MARUTHI MADHAV SUNKARA MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 99 EAST STATE ST., MEDICAL ARTS BLDG SUITE 105
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City | GLOVERSVILLE
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State | NY
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Zip | 12078
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Country | US
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Telephone | 518-775-4234
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Fax | 518-775-4271
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Provider Business Mailing Address
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Address Line | 99 E STATE ST PO BOX 1250
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1203
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Country | US
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Telephone | 518-775-4205
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Fax | 518-775-5456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 241793
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License Number State | NY
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