MEDICARE: DR. MAGESH SUNDARAM MD

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	208600000X	Surgery Physician	C1-0004534	DE
2	2086X0206X	Surgical Oncology Physician	036130584	IL
3	2086X0206X	Surgical Oncology Physician	D0052627	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00266429	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	36066	OTHER	NCI INVESTIGATOR ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114924735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGESH SUNDARAM MD

Provider Business Mailing Address
First Line	:	PO BOX 64226
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4226
Country	:	US
Telephone Number	:	667-214-1734
Fax Number	:	410-706-6976

Provider Business Practice Location Address
First Line	:	14999 HEALTH CENTER DR STE 201
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1087
Country	:	US
Telephone Number	:	667-214-1718
Fax Number	:	410-328-5147

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	04/04/2023

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Directions to “ DR. MAGESH SUNDARAM MD” Practice Location

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