MEDICARE: SAMPATH GUNDA 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	4301117176	MI
2	207RC0000X	Cardiovascular Disease Physician	4301117176	MI
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	35.149985	OH

General Provider Information

NPI Number	:	1477865301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMPATH GUNDA MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-7677
Fax Number	:	614-293-5614

Provider Business Practice Location Address
First Line	:	452 W 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-293-7677
Fax Number	:	614-293-5614

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	04/20/2026

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