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Organization

DHANRAJ J. SOOGREE M.D. P.C.

Active
Other names
Fourth Street Family Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
DHANRAJ JATTAN SOOGREE M.D. (OWNER)
(315) 342-2521
Entity
Organization

Contact information

Practice address
144 W 4TH ST, OSWEGO, NY 13126-2504
(315) 342-2521
(315) 342-4277
Mailing address
144 W 4TH ST, OSWEGO, NY 13126-2504
(315) 342-2521
(315) 342-4277

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210443
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000115478
BLUE SHIELD
NY
05
01857538
NY
01
1194755322
BCBS NY EXCELLUS
NY
Enumeration date
03/28/2008
Last updated
02/22/2010
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