Provider Demographics
NPI:1609074905
Name:SATHASIVAM, ANPALAKAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANPALAKAN
Middle Name:
Last Name:SATHASIVAM
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 1:37767 MARKET DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3188
Mailing Address - Country:US
Mailing Address - Phone:301-884-7330
Mailing Address - Fax:
Practice Address - Street 1:37767 MARKET DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3188
Practice Address - Country:US
Practice Address - Phone:301-884-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036648207R00000X, 207RE0101X, 208000000X, 2080P0205X
MDD71567207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330507400Medicaid