Provider Demographics
NPI:1942306238
Name:DANG, SUDERSHAN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDERSHAN
Middle Name:KUMAR
Last Name:DANG
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 1:2701 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6222
Mailing Address - Country:US
Mailing Address - Phone:315-735-7573
Mailing Address - Fax:315-735-4713
Practice Address - Street 1:2701 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6222
Practice Address - Country:US
Practice Address - Phone:315-735-7573
Practice Address - Fax:315-735-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143273Medicaid
NY179033-6OtherWORKERS COMP #
NY01143273Medicaid
NYE15710Medicare UPIN