Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 133288 | NY |
NPI | 1073573606 |
---|---|
Provider Name | Suhas V. Pradhan |
First Address | Syracuse, NY 13210-1603 |
Second Address | Syracuse, NY 13210-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00458659 | (05) | NY |
B82134 | (02) | NY |