Provider Demographics
NPI:1265631899
Name:SUNKARA, MARUTHI MADHAV (MD)
Entity Type:Individual
Prefix:
First Name:MARUTHI
Middle Name:MADHAV
Last Name:SUNKARA
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 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-775-4205
Mailing Address - Fax:518-775-5456
Practice Address - Street 1:99 EAST STATE ST.,
Practice Address - Street 2:MEDICAL ARTS BLDG SUITE 105
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-775-4234
Practice Address - Fax:518-775-4271
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4158884OtherMVP HEALTHPLAN
NY02298671Medicaid
NY10127405OtherCDPHP
NY02298671Medicaid