Provider Demographics
NPI:1134118532
Name:NAGARATHINAM, SUNDARAM VEERAPANDIAN (MD)
Entity Type:Individual
Prefix:
First Name:SUNDARAM
Middle Name:VEERAPANDIAN
Last Name:NAGARATHINAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 LEE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4852
Mailing Address - Country:US
Mailing Address - Phone:239-369-6211
Mailing Address - Fax:239-369-1209
Practice Address - Street 1:1154 LEE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:239-369-6211
Practice Address - Fax:239-369-1209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0029077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58641Medicare UPIN
79085Medicare ID - Type Unspecified