Provider Demographics
NPI:1619004926
Name:PRAKASH, SUMA (MD, MSC, FRCPC)
Entity Type:Individual
Prefix:
First Name:SUMA
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD, MSC, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 675
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1554
Mailing Address - Fax:585-442-9201
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-5103
Practice Address - Country:US
Practice Address - Phone:585-275-4517
Practice Address - Fax:585-442-9201
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY314780363AM0700X, 207RN0300X
ZZ73417207RN0300X
PAMD460537207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical