Provider Demographics
NPI:1477638963
Name:BALACHANDRAN, SUNDARAMURTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNDARAMURTHY
Middle Name:
Last Name:BALACHANDRAN
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 1:1429 ROUTE 169
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281
Mailing Address - Country:US
Mailing Address - Phone:860-501-0857
Mailing Address - Fax:860-315-7077
Practice Address - Street 1:145 POMFRET STREET
Practice Address - Street 2:RIVERVIEW MEDICAL ASSOCIATES
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-928-5248
Practice Address - Fax:860-928-5286
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30413Medicare UPIN