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NPI Code Detail

MEDICARE: BABURAO N SAMUDRALA MD

MEDICARE: BABURAO N SAMUDRALA 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 Physician138827-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962459008
Entity Type Code : Individual
Provider Name (Legal Business Name) : BABURAO N SAMUDRALA MD
Provider Business Mailing Address
First Line : PO BOX 340
Second Line :
City : NEW HARTFORD
State : NY
Zip : 13413-0340
Country : US
Telephone Number : 315-732-9368
Fax Number : 315-732-9403
Provider Business Practice Location Address
First Line : 460 ANDES RD
Second Line : PHYSICIANS OFFICE BUILDING
City : DELHI
State : NY
Zip : 13753-7407
Country : US
Telephone Number : 607-746-6266
Fax Number : 607-746-6266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 03/07/2023

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Directions to “ BABURAO N SAMUDRALA MD” Practice Location

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