Provider Demographics
NPI:1710092804
Name:SUDHIR, KENKERE G (MD)
Entity Type:Individual
Prefix:
First Name:KENKERE
Middle Name:G
Last Name:SUDHIR
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 1:37 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6008
Mailing Address - Country:US
Mailing Address - Phone:603-882-1501
Mailing Address - Fax:603-882-9747
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-882-1501
Practice Address - Fax:603-882-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6290207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009584Medicaid
NHNH9584Medicare ID - Type Unspecified
NHB86222Medicare UPIN