Provider Demographics
NPI:1205837606
Name:SUNDARAM, PALANISWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:PALANISWAMY
Middle Name:
Last Name:SUNDARAM
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 1:3 SAINT FRANCIS WAY
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5122
Mailing Address - Country:US
Mailing Address - Phone:724-779-7960
Mailing Address - Fax:724-772-1130
Practice Address - Street 1:3 SAINT FRANCIS WAY
Practice Address - Street 2:UNIT 2
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5122
Practice Address - Country:US
Practice Address - Phone:724-779-7960
Practice Address - Fax:724-772-1130
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058175L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053976TE1Medicare ID - Type Unspecified
PAG54641Medicare UPIN