MEDICARE: DR. ANNAMALAI PERIAKARUPPAN 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	208600000X	Surgery Physician	1562261	NY

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

General Provider Information

NPI Number	:	1801851324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNAMALAI PERIAKARUPPAN MD

Provider Business Mailing Address
First Line	:	180 HARRY L DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1566
Country	:	US
Telephone Number	:	607-763-1122
Fax Number	:	607-763-1331

Provider Business Practice Location Address
First Line	:	180 HARRY L DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1566
Country	:	US
Telephone Number	:	607-763-1122
Fax Number	:	607-763-1331

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	11/11/2008

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