Provider Demographics
NPI:1366786998
Name:CHIRUMAMILLA, VASU (MD)
Entity type:Individual
Prefix:DR
First Name:VASU
Middle Name:
Last Name:CHIRUMAMILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MANOR CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2221
Mailing Address - Country:US
Mailing Address - Phone:716-553-2550
Mailing Address - Fax:
Practice Address - Street 1:156 ROUTE 59 STE A2
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5013
Practice Address - Country:US
Practice Address - Phone:845-517-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267016208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery