Provider Demographics
NPI:1306804125
Name:DESHMUKH, SUDIPT S (MBBS)
Entity type:Individual
Prefix:
First Name:SUDIPT
Middle Name:S
Last Name:DESHMUKH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4112
Mailing Address - Country:US
Mailing Address - Phone:585-225-0410
Mailing Address - Fax:
Practice Address - Street 1:2350 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4112
Practice Address - Country:US
Practice Address - Phone:585-225-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110242029OtherMEDICARE RAILROAD
NY00355266Medicaid
NY17817QMedicare ID - Type Unspecified
F96738Medicare UPIN
NY00355266Medicaid