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General NPI Number Information
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NPI Number | 1114924735
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Entity Type | Individual
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Provider Name | MAGESH SUNDARAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2005
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 14999 HEALTH CENTER DR STE 201
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City | BOWIE
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State | MD
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Zip | 20716-1087
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Country | US
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Telephone | 667-214-1718
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Fax | 410-328-5147
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Provider Business Mailing Address
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Address Line | PO BOX 64226
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City | BALTIMORE
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State | MD
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Zip | 21264-4226
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Country | US
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Telephone | 667-214-1734
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Fax | 410-706-6976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C1-0004534
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 036130584
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | D0052627
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License Number State | MD
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