Provider Demographics
NPI:1376513085
Name:VOHRA, SANJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:VOHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 TAUGHANNOCK BLVD
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3328
Mailing Address - Country:US
Mailing Address - Phone:607-277-4035
Mailing Address - Fax:607-277-3888
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:SUITE M
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-273-8502
Practice Address - Fax:607-273-6115
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY191391208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01682920Medicaid
NYG17788Medicare UPIN
NY01682920Medicaid