Provider Demographics
NPI:1265726822
Name:SUDARSANAN BISMARK, RASHMI (MD)
Entity type:Individual
Prefix:
First Name:RASHMI
Middle Name:
Last Name:SUDARSANAN BISMARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RASHMI
Other - Middle Name:THIRUMULPAD
Other - Last Name:SUDARSANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1125
Mailing Address - Country:US
Mailing Address - Phone:315-363-5375
Mailing Address - Fax:
Practice Address - Street 1:110 WAYLAND ST
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1125
Practice Address - Country:US
Practice Address - Phone:315-363-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program