Provider Demographics
NPI:1215669965
Name:WALIA, SUKHCHARAN (MD)
Entity type:Individual
Prefix:
First Name:SUKHCHARAN
Middle Name:
Last Name:WALIA
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 1:54 NOLL ST APT 763
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5365
Mailing Address - Country:US
Mailing Address - Phone:907-302-7744
Mailing Address - Fax:
Practice Address - Street 1:54 NOLL ST APT 763
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5365
Practice Address - Country:US
Practice Address - Phone:907-302-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
WAMD61658352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty