Provider Demographics
NPI:1952382251
Name:BHADURI-MCINTOSH, SUMITA (MD)
Entity Type:Individual
Prefix:
First Name:SUMITA
Middle Name:
Last Name:BHADURI-MCINTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-294-5252
Mailing Address - Fax:352-294-8068
Practice Address - Street 1:1600 SW ARCHER RD BOX 100296
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1526
Practice Address - Country:US
Practice Address - Phone:352-294-5252
Practice Address - Fax:352-294-8068
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0394802080P0208X
FLME1332762080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021896200Medicaid
H27549Medicare UPIN
FL021896200Medicaid