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General NPI Number Information
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NPI Number | 1144487430
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Entity Type | Organization
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Legal Business Name | MALATHY T. SUNDARAM, M. D. LLC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 25A JUNE ST SUITE 111
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City | SANFORD
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State | ME
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Zip | 04073-2642
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Country | US
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Telephone | 207-324-5968
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Fax | 207-490-1758
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Provider Business Mailing Address
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Address Line | 25A JUNE ST SUITE 111
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City | SANFORD
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State | ME
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Zip | 04073-2642
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Country | US
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Telephone | 207-324-5968
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Fax | 207-490-1758
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Authorized Official
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Title or Position | DOCTOR
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Name | MALATHY T SUNDARAM
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Credential | M. D.
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Telephone | 207-324-5968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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