Individual
MS. MARY SUJANA KANTHARAJ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
15 RIVERSIDE DR, JOHNSON CITY, NY 13790-2742
(607) 770-9050
(607) 770-9091
Mailing address
15 RIVERSIDE DR, JOHNSON CITY, NY 13790-2742
(607) 770-9050
(607) 770-9091
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009664
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01283132
—
NY
Enumeration date
10/27/2005
Last updated
07/09/2007
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