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NPI Code Detail

MEDICARE: POONGOTHAI SUNDARAM MD

MEDICARE: POONGOTHAI 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
1207RX0202XMedical Oncology Physician35074867OH
2207RH0003XHematology & Oncology Physician35074867OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000201367OTHEROHANTHEM BC/BS
33600657OTHEROHUNITED HEALTHCARE

General Provider Information

NPI Number : 1538127238
Entity Type Code : Individual
Provider Name (Legal Business Name) : POONGOTHAI SUNDARAM MD
Provider Business Mailing Address
First Line : PO BOX 749495
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9495
Country : US
Telephone Number : 239-432-8331
Fax Number : 813-321-1296
Provider Business Practice Location Address
First Line : 3100 PLAZA PROPERTIES BLVD
Second Line :
City : COLUMBUS
State : OH
Zip : 43219-1530
Country : US
Telephone Number : 614-383-6000
Fax Number : 614-383-6001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 01/11/2023

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Directions to “ POONGOTHAI SUNDARAM MD” Practice Location

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