Provider Demographics
NPI:1851300271
Name:MURUKUTLA, SEETHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SEETHA
Middle Name:R
Last Name:MURUKUTLA
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 1:15 OLD FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1439
Mailing Address - Country:US
Mailing Address - Phone:718-979-2523
Mailing Address - Fax:718-273-3114
Practice Address - Street 1:1384 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3908
Practice Address - Country:US
Practice Address - Phone:718-273-2277
Practice Address - Fax:718-273-3114
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151450207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00899541Medicaid
NY2Z4511OtherEMPIREBC/BS PROVIDER ID #
NY2Z4511OtherEMPIREBC/BS PROVIDER ID #
NY00899541Medicaid