Provider Demographics
NPI:1407840515
Name:NANDA, SUMIT K (MD)
Entity Type:Individual
Prefix:
First Name:SUMIT
Middle Name:K
Last Name:NANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:STE 750
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-948-2020
Mailing Address - Fax:405-948-2760
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:STE 750
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-948-2020
Practice Address - Fax:405-948-2760
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18577207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096150BMedicaid
E94908Medicare UPIN
OK800522012Medicare PIN