Provider Demographics
NPI:1962428110
Name:SUTARIA, BHAGWANDAS L (MD)
Entity type:Individual
Prefix:DR
First Name:BHAGWANDAS
Middle Name:L
Last Name:SUTARIA
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 1:320 PRATHER AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6820
Mailing Address - Country:US
Mailing Address - Phone:716-664-5712
Mailing Address - Fax:716-664-4111
Practice Address - Street 1:320 PRATHER AVENUE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6820
Practice Address - Country:US
Practice Address - Phone:716-664-5712
Practice Address - Fax:716-664-4111
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119406207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000507251001OtherBCBS
NY00640253Medicaid
D74925Medicare UPIN
35054BMedicare ID - Type Unspecified