Provider Demographics
NPI:1194932731
Name:KOTIKELA, SUMATHI (MD)
Entity type:Individual
Prefix:
First Name:SUMATHI
Middle Name:
Last Name:KOTIKELA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2228
Mailing Address - Country:US
Mailing Address - Phone:845-306-0910
Mailing Address - Fax:845-306-0911
Practice Address - Street 1:2891 ROUTE 22
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2228
Practice Address - Country:US
Practice Address - Phone:845-306-0910
Practice Address - Fax:845-306-0911
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03734278Medicaid
NY03734278Medicaid