Provider Demographics
NPI:1730258625
Name:DHANYAMRAJU, SUMITRA (MD)
Entity type:Individual
Prefix:
First Name:SUMITRA
Middle Name:
Last Name:DHANYAMRAJU
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 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:75 ORANGE AVE
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1816
Practice Address - Country:US
Practice Address - Phone:845-778-2700
Practice Address - Fax:845-778-2945
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 432014207Q00000X
NY208516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01841634Medicaid
PA124732KQCOtherOTHER MEDICARE ID #
NY01841634Medicaid
PA124732KQCOtherOTHER MEDICARE ID #
CC1580Medicare ID - Type Unspecified