Provider Demographics
NPI:1780775601
Name:MYSOREKAR, UMA VASANT (MD)
Entity type:Individual
Prefix:MRS
First Name:UMA
Middle Name:VASANT
Last Name:MYSOREKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9425 57TH AVE
Mailing Address - Street 2:SUITE P3
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-592-6474
Mailing Address - Fax:718-592-9734
Practice Address - Street 1:9425 57TH AVE
Practice Address - Street 2:SUITE P3
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-592-6474
Practice Address - Fax:718-592-9734
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY123181207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00231558Medicaid
NY20699Medicare UPIN
NY55336AMedicare ID - Type Unspecified