Provider Demographics
NPI:1073573606
Name:PRADHAN, SUHAS V (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:V
Last Name:PRADHAN
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 1:725 IRVING AVE
Mailing Address - Street 2:STE 514
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-475-8409
Mailing Address - Fax:315-475-6026
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE 514
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-475-8409
Practice Address - Fax:315-475-6026
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY133288208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00458659Medicaid
NY38665BMedicare ID - Type Unspecified
NY00458659Medicaid