Provider Demographics
NPI:1790774529
Name:VYAVAHARKAR, PURNIMA (MD)
Entity Type:Individual
Prefix:
First Name:PURNIMA
Middle Name:
Last Name:VYAVAHARKAR
Suffix:
Gender:F
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:PO BOX 2001
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4501
Mailing Address - Country:US
Mailing Address - Phone:315-449-2208
Mailing Address - Fax:315-362-5120
Practice Address - Street 1:8400 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1004
Practice Address - Country:US
Practice Address - Phone:315-652-7939
Practice Address - Fax:315-652-6331
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics