Provider Demographics
NPI:1669469912
Name:VERMA, SANJEEV KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:KUMAR
Last Name:VERMA
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 1:2316 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2839
Mailing Address - Country:US
Mailing Address - Phone:315-463-5107
Mailing Address - Fax:315-463-6029
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:AL LEE MEMORIAL HOSPITAL
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2904
Practice Address - Country:US
Practice Address - Phone:315-591-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186598207L00000X, 207LC0200X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3837085OtherECFMG
NY01613698Medicaid
NY01613698Medicaid
F97915Medicare UPIN
NYJ400002667Medicare PIN
55730BMedicare ID - Type Unspecified