Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2020-00506 | NC |
NPI | 1023495108 |
---|---|
Provider Name | Suman Medda |
First Address | Charlotte, NC 28219-9305 |
Second Address | Brooklyn, NY 11220-5350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 12/11/2021 |