1811971922 NPI number — SUNDARESAN T SAMBANDAM M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811971922 NPI number — SUNDARESAN T SAMBANDAM M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SAMBANDAM

Provider First Name:

SUNDARESAN

Provider Middle Name:

T

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1811971922

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/09/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1220 PONTIAC AVE

Provider Second Line Business Mailing Address:

SUITE 101

Provider Business Mailing Address City Name:

CRANSTON

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02920-4456

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-943-4660

Provider Business Mailing Address Fax Number:

401-943-0240

Provider First Line Business Practice Location Address:

1220 PONTIAC AVE

Provider Second Line Business Practice Location Address:

SUITE 101

Provider Business Practice Location Address City Name:

CRANSTON

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02920-4456

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-943-4660

Provider Business Practice Location Address Fax Number:

401-943-0240

Provider Enumeration Date:

12/01/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RH0003X , with the licence number:  05372 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 720024001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 30-00050 . This is a "UHC OF NE,INC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 0000002589 . This is a "BC/BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 005372 . This is a "TUFTS HP" identifier . This identifiers is of the category "OTHER".
• Identifier: 9475RIH . This is a "HARVARD PILGRIM HP" identifier . This identifiers is of the category "OTHER".
• Identifier: RI0007390 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 001994 . This is a "BLUECHIP/RIBCBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 0173690 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0513005 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7003434 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 2376 . This is a "NEIGHBORHOOD HEATH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 4549333 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".