MEDICARE: DR. SUKUMAR PUVVALA 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
1	2085R0202X	Diagnostic Radiology Physician	MD421519	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7581465	OTHER	PA	AETNA
4	50074893	OTHER	PA	CAPITAL BLUE CROSS WMG
5	919374	OTHER	MD	CAREFIRST MD BCBS
6	235944	OTHER	PA	UNISON-WMG
7	1468864	OTHER	PA	HIGHMARK BLUE SHIELD
8	1530454	OTHER	PA	GATEWAY-WMG
9	2006917	OTHER	PA	AMERIHEALTH MERCY WMG
10	212042	OTHER	PA	JOHN HOPKINS

General Provider Information

NPI Number	:	1164418075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKUMAR PUVVALA MD

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-815-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 MONUMENT RD
Second Line	:	SUITE 201
City	:	YORK
State	:	PA
Zip	:	17403-5074
Country	:	US
Telephone Number	:	717-812-4083
Fax Number	:	717-812-2244

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	02/09/2026

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Directions to “ DR. SUKUMAR PUVVALA MD” Practice Location

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