Provider Demographics
NPI:1497047641
Name:CHETTIAR, SUNDARAM KRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:SUNDARAM
Middle Name:KRISHNAN
Last Name:CHETTIAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 WILKENS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5216
Mailing Address - Country:US
Mailing Address - Phone:667-234-2922
Mailing Address - Fax:
Practice Address - Street 1:3449 WILKENS AVE STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5218
Practice Address - Country:US
Practice Address - Phone:667-234-2922
Practice Address - Fax:667-234-9997
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD79893207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine