Provider Demographics
NPI:1083771927
Name:MIHINDUKULASURIYA, JOSEPH CARLTON (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CARLTON
Last Name:MIHINDUKULASURIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:C
Other - Last Name:MIHINDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20 MURRAY ST
Mailing Address - Street 2:PO BOX 2018
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4320
Mailing Address - Country:US
Mailing Address - Phone:518-798-3838
Mailing Address - Fax:518-798-6125
Practice Address - Street 1:20 MURRAY STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2018
Practice Address - Country:US
Practice Address - Phone:518-798-3838
Practice Address - Fax:518-798-6125
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1550461207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00819109Medicaid
NY00819109Medicaid
NYRB8234Medicare PIN