Provider Demographics
NPI:1366412264
Name:NARASIMHADEVARA, SATYANARAYANA MURTHY (MD)
Entity type:Individual
Prefix:DR
First Name:SATYANARAYANA
Middle Name:MURTHY
Last Name:NARASIMHADEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SKIDMORE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5000
Mailing Address - Country:US
Mailing Address - Phone:845-454-9820
Mailing Address - Fax:
Practice Address - Street 1:301 MANCHESTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2586
Practice Address - Country:US
Practice Address - Phone:845-471-7417
Practice Address - Fax:845-471-7906
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117137Medicaid
NYH06843Medicare UPIN
NY02117137Medicaid