Individual
GOWDARA DIVAKARA MURTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2546 BALLTOWN RD, SUITE 200, SCHENECTADY, NY 12309-1079
(518) 374-1444
(518) 374-0491
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
208468
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03299543
—
NY
01
—
130712000045
FIDELIS
NY
01
—
7795243
AETNA
NY
01
—
781CB1
EMPIRE BLUECROSS BLUESHIELD
NY
Enumeration date
08/11/2006
Last updated
01/18/2018
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