Provider Demographics
NPI:1649243130
Name:GARGYA, SUKUMAR C (MD)
Entity Type:Individual
Prefix:
First Name:SUKUMAR
Middle Name:C
Last Name:GARGYA
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 1:2745 SPINNAKER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-5759
Mailing Address - Country:US
Mailing Address - Phone:775-996-4042
Mailing Address - Fax:775-401-6262
Practice Address - Street 1:10623 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5833
Practice Address - Country:US
Practice Address - Phone:775-996-4042
Practice Address - Fax:775-401-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11678602OtherCAQH
NVP00166116OtherRAILROAD MEDICARE
NV100504481Medicaid
NVP00166116OtherRAILROAD MEDICARE
NV100504481Medicaid
11678602OtherCAQH
NVGS513YMedicare PIN
NV1649243130Medicaid