Provider Demographics
NPI:1013018118
Name:DHAWAN, SUSHIL KUMAR (MD,DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:KUMAR
Last Name:DHAWAN
Suffix:
Gender:M
Credentials:MD,DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2115
Mailing Address - Country:US
Mailing Address - Phone:845-324-4774
Mailing Address - Fax:845-343-8741
Practice Address - Street 1:111 MALTESE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2115
Practice Address - Country:US
Practice Address - Phone:845-324-4774
Practice Address - Fax:845-343-8741
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236965207X00000X
NYN0005909-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY742F11Medicare PIN