Provider Demographics
NPI:1750359055
Name:SUKUMARAN, SUNITHA (MD)
Entity type:Individual
Prefix:
First Name:SUNITHA
Middle Name:
Last Name:SUKUMARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 ROUTE 146 STE 101
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3239
Mailing Address - Country:US
Mailing Address - Phone:518-373-3924
Mailing Address - Fax:518-373-3808
Practice Address - Street 1:3 CROSSING BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4172
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238650207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01235261OtherRAILROAD MEDICARE
NY3566176Medicaid
NYJ400088566Medicare PIN
NYA400085947Medicare PIN
ILI49914Medicare UPIN