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General NPI Number Information
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NPI Number | 1811188659
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Entity Type | Individual
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Provider Name | PRATHIMA KANUMURI M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 2210 TROY SCHENECTADY RD
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City | NISKAYUNA
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State | NY
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Zip | 12309-4725
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Country | US
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Telephone | 518-612-8560
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Fax | 518-612-8561
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Provider Business Mailing Address
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Address Line | 1201 NOTT ST SUITE 103
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City | SCHENECTADY
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State | NY
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Zip | 12308-2589
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Country | US
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Telephone | 518-612-8560
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Fax | 518-612-8561
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 256886
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License Number State | NY
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