Healthcare Provider Details

I. General information

NPI: 1053363176
Provider Name (Legal Business Name): MALATHY T SUNDARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROCHESTER HILL RD STE 7
ROCHESTER NH
03867-3235
US

IV. Provider business mailing address

60 ROCHESTER HILL RD STE 7
ROCHESTER NH
03867-3235
US

V. Phone/Fax

Practice location:
  • Phone: 207-850-1079
  • Fax: 207-324-0911
Mailing address:
  • Phone: 207-850-1079
  • Fax: 207-324-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number13607
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13607
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: