MEDICARE: DR. PALANISWAMY SUNDARAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD058175L	PA

General Provider Information

NPI Number	:	1205837606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PALANISWAMY SUNDARAM M.D.

Provider Business Mailing Address
First Line	:	3 SAINT FRANCIS WAY
Second Line	:	SUITE 202A
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5122
Country	:	US
Telephone Number	:	724-779-7960
Fax Number	:	724-772-1130

Provider Business Practice Location Address
First Line	:	3 SAINT FRANCIS WAY
Second Line	:	UNIT 2
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5122
Country	:	US
Telephone Number	:	724-779-7960
Fax Number	:	724-772-1130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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