Provider Demographics
NPI:1336484708
Name:BOORA, SOWMYA (MD)
Entity Type:Individual
Prefix:
First Name:SOWMYA
Middle Name:
Last Name:BOORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOWMYA
Other - Middle Name:
Other - Last Name:KODIPYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:4230 CRUMS MILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2898
Practice Address - Country:US
Practice Address - Phone:717-233-6171
Practice Address - Fax:717-233-6171
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262453207R00000X
PAMD468376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine