Provider Demographics
NPI:1790773984
Name:SONTHINENI, GOVARDHAN (MD)
Entity Type:Individual
Prefix:
First Name:GOVARDHAN
Middle Name:
Last Name:SONTHINENI
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 1:38 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4712
Mailing Address - Country:US
Mailing Address - Phone:607-772-9556
Mailing Address - Fax:607-772-9558
Practice Address - Street 1:38 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4712
Practice Address - Country:US
Practice Address - Phone:607-772-9556
Practice Address - Fax:607-772-9558
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01149471Medicaid
52897CMedicare ID - Type Unspecified
NY01149471Medicaid