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General NPI Number Information
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NPI Number | 1811971922
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Entity Type | Individual
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Provider Name | SUNDARESAN T SAMBANDAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 1220 PONTIAC AVE SUITE 101
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City | CRANSTON
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State | RI
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Zip | 02920-4456
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Country | US
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Telephone | 401-943-4660
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Fax | 401-943-0240
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Provider Business Mailing Address
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Address Line | 455 TOLL GATE RD
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City | WARWICK
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State | RI
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Zip | 02886-2759
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Country | US
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Telephone | 401-273-0641
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Fax | 401-273-2919
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 05372
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License Number State | RI
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