Provider Demographics
NPI:1225015654
Name:SWAMINATHAN, SUNDARARAMAN (MBBS)
Entity Type:Individual
Prefix:
First Name:SUNDARARAMAN
Middle Name:
Last Name:SWAMINATHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61286207RN0300X
MN46120207RN0300X
ARE4687207RN0300X
VA0101252742207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN792647200Medicaid
AR5N481OtherBLUE CROSS BLUE SHIELD
AR06030015400OtherQUALCHOICE
ARP00038096OtherRAILROAD MEDICARE
AR160049001Medicaid
ARP00395926OtherRAILROAD MEDICARE
ARE4687OtherTRICARE
MN792647200Medicaid
ARP00395926OtherRAILROAD MEDICARE
ARP00038096OtherRAILROAD MEDICARE