Provider Demographics
NPI:1902838154
Name:PULUKURTHY, SATYAVARDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SATYAVARDHAN
Middle Name:
Last Name:PULUKURTHY
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 1:2709 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2623
Mailing Address - Country:US
Mailing Address - Phone:360-782-6000
Mailing Address - Fax:206-965-4119
Practice Address - Street 1:2709 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2623
Practice Address - Country:US
Practice Address - Phone:360-782-6000
Practice Address - Fax:206-965-4119
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046428207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021738Medicaid
WA8453888Medicaid
WA8858892Medicare ID - Type Unspecified