Provider Demographics
NPI:1467631176
Name:PURUSHOTHAM, ARCHANA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:PURUSHOTHAM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEUROLOGY ASSOCIATES
Mailing Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL HSC T12-020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-8118
Mailing Address - Fax:
Practice Address - Street 1:NEUROLOGY ASSOCIATES
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL HSC T12-020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2872612084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology