Basic Information
| Provider Information | |||||||||
| NPI: | 1245562685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOIRALA | ||||||||
| FirstName: | SUMIRA | ||||||||
| MiddleName: | ADHIKARI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8423 MARKET ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307298700 | ||||||||
| FaxNumber: | 3307298701 | ||||||||
| Practice Location | |||||||||
| Address1: | 8423 MARKET ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307298700 | ||||||||
| FaxNumber: | 3307298701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2010 | ||||||||
| LastUpdateDate: | 12/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.098403 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0069459 | 05 | OH | MEDICAID |