Provider Demographics
NPI:1811188659
Name:KANUMURI, PRATHIMA (MD)
Entity Type:Individual
Prefix:
First Name:PRATHIMA
Middle Name:
Last Name:KANUMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-612-8560
Mailing Address - Fax:518-612-8561
Practice Address - Street 1:2210 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4725
Practice Address - Country:US
Practice Address - Phone:518-612-8560
Practice Address - Fax:518-612-8561
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY256886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04227556Medicaid