Provider Demographics
NPI:1972758787
Name:NUTHALAPATY, SAM SUMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:SUMAN
Last Name:NUTHALAPATY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1217 AVALON SQ
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2876
Mailing Address - Country:US
Mailing Address - Phone:347-427-6848
Mailing Address - Fax:718-920-5180
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER NORTH DIVISION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9000
Practice Address - Fax:718-920-9160
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2011-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY131740114282N00000X
NY258371282N00000X
CT049139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital