Provider Demographics
NPI:1720073091
Name:ROY, SUNIL C (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:C
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:255 MAIN STREET
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0983
Mailing Address - Country:US
Mailing Address - Phone:606-633-2261
Mailing Address - Fax:606-633-9643
Practice Address - Street 1:214 HOSPITAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7627
Practice Address - Country:US
Practice Address - Phone:606-633-2255
Practice Address - Fax:606-633-3814
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22189208600000X
VA0101036968208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64221898Medicaid
C36658Medicare UPIN
KY64221898Medicaid
VA020000916Medicare PIN