Provider Demographics
NPI:1447273396
Name:POPURI, PURNACHANDRA R (MD)
Entity type:Individual
Prefix:DR
First Name:PURNACHANDRA
Middle Name:R
Last Name:POPURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:225 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2147
Mailing Address - Country:US
Mailing Address - Phone:315-363-9064
Mailing Address - Fax:315-363-6673
Practice Address - Street 1:225 BROAD ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2147
Practice Address - Country:US
Practice Address - Phone:315-363-9064
Practice Address - Fax:315-363-6673
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166839-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01109580Medicaid
NY51461BMedicare ID - Type Unspecified
NY01109580Medicaid