Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 149639 | NY |
NPI | 1134464233 |
---|---|
Provider Name | Dr. Padma Sundaram |
First Address | Middletown, NY 10940-5053 |
Second Address | Middletown, NY 10940-5053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149639 | NEW YORK STATE LICENCE (01) | NY |