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NPI Code Detail

MEDICARE: SUSHAMA KOTMIRE THANDLA MD

MEDICARE: SUSHAMA KOTMIRE THANDLA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician238894NY

General Provider Information

NPI Number : 1003897414
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSHAMA KOTMIRE THANDLA MD
Provider Business Mailing Address
First Line : 112 NOLAN DR
Second Line :
City : ALLEGANY
State : NY
Zip : 14706-1115
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 987 R C HOAG DR
Second Line :
City : SALAMANCA
State : NY
Zip : 14779-1365
Country : US
Telephone Number : 716-945-5894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 02/20/2015

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Directions to “ SUSHAMA KOTMIRE THANDLA MD” Practice Location

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