Provider Demographics
NPI:1649214719
Name:SULKOW, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SULKOW
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:TROY ANESTHESIOLOGISTS, PC.
Mailing Address - Street 2:P.O. BOX 3308
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3308
Mailing Address - Country:US
Mailing Address - Phone:866-868-8419
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:SAMARITAN HOSPITAL
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3208
Practice Address - Fax:518-271-3258
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156676-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00846933Medicaid
NY56454DMedicare ID - Type Unspecified
NY00846933Medicaid