Provider Demographics
NPI:1558454546
Name:SHANTHARAM, SANAGARAM S (MD)
Entity Type:Individual
Prefix:
First Name:SANAGARAM
Middle Name:S
Last Name:SHANTHARAM
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 1:7065 N MAPLE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8013
Mailing Address - Country:US
Mailing Address - Phone:559-322-0887
Mailing Address - Fax:559-322-0888
Practice Address - Street 1:7065 N MAPLE AVE
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8013
Practice Address - Country:US
Practice Address - Phone:559-322-0887
Practice Address - Fax:559-322-0888
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52010207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1305390001Medicare NSC
CA00A520100Medicare ID - Type Unspecified
S26216Medicare UPIN