Mary Sujana Kantharaj, RPA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

009664 Issued in NY

Practice address

15 Riverside Dr
Johnson City, NY 13790-2742

Phone

(607) 770-9050

Fax

(607) 770-9091

NPI assigned

Oct 27, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1417947631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902742",
            "telephone_number": "607-770-9050",
            "fax_number": "607-770-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902742",
            "telephone_number": "607-770-9050",
            "fax_number": "607-770-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTHARAJ",
        "first_name": "MARY",
        "middle_name": "SUJANA",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-27",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "009664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01283132",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Lee Kahn, MD
• Mansi Kallem, M.D.
• Tracey Kaminsky, HIS
• Vivek Vardhan Reddy Kandanati, M.D.
• Hank Kang, MD
• Danielle Tchir Kappel, PA
• Eya Karabibene
• Sathappan Karuppiah, MD
• Hisham Kashou, MD
• Himabindu Kasivajjula, M.D.

• Medical Physician Assistant in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.