Provider Demographics
NPI:1083064943
Name:SARKISOVA, INNESA (MD)
Entity Type:Individual
Prefix:
First Name:INNESA
Middle Name:
Last Name:SARKISOVA
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 1:624 MCCLELLAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-347-5293
Mailing Address - Fax:518-347-5196
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-347-5293
Practice Address - Fax:518-347-5196
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine