MEDICARE: DR. VENKATA SATISH KUMAR SAMPATHI MBBS

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
1	207L00000X	Anesthesiology Physician	003574	NY

General Provider Information

NPI Number	:	1073825071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA SATISH KUMAR SAMPATHI MBBS

Provider Business Mailing Address
First Line	:	163 INTREPID LANE
Second Line	:	UPSTATE MEDICAL ANESTHESIOLOGY GROUP, INC.
City	:	SYRACUSE
State	:	NY
Zip	:	13205-2548
Country	:	US
Telephone Number	:	315-469-1130
Fax Number	:	315-469-1134

Provider Business Practice Location Address
First Line	:	750 E. ADAMS ST
Second Line	:	UPSTATE MEDICAL UNIVERSITY
City	:	SYRACUSE
State	:	NY
Zip	:	13210-1834
Country	:	US
Telephone Number	:	315-469-1130
Fax Number	:	315-469-1134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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