Basic Information
| Provider Information | |||||||||
| NPI: | 1588902316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTHE | ||||||||
| FirstName: | SUMANTH | ||||||||
| MiddleName: | VAMSHIDHAR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C, M.M.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 CHARLES PLZ APT 1307 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212014221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439833210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9710 BRIMHALL RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933122779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618296747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA22801 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.