Provider Demographics
NPI:1467694596
Name:PUTCHA, SURY M (MD)
Entity Type:Individual
Prefix:
First Name:SURY
Middle Name:M
Last Name:PUTCHA
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 1:201 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4816
Mailing Address - Country:US
Mailing Address - Phone:607-785-2050
Mailing Address - Fax:607-785-2034
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4816
Practice Address - Country:US
Practice Address - Phone:607-785-2050
Practice Address - Fax:607-785-2034
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100032207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100032OtherNY STATE LICENSE