Provider Demographics
NPI:1689736324
Name:SANDELLA, SURENDER KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SURENDER
Middle Name:KUMAR
Last Name:SANDELLA
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 1:2109 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4693
Mailing Address - Country:US
Mailing Address - Phone:812-948-2232
Mailing Address - Fax:812-945-0869
Practice Address - Street 1:2109 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4693
Practice Address - Country:US
Practice Address - Phone:812-948-2232
Practice Address - Fax:812-945-0869
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069610A207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504691OtherBCBS AL
060066788OtherPALMETTO GBA RR MEDICARE
AL009965760Medicaid
TN4029085OtherBCBS TN
MS03055020Medicaid
2510727OtherUNITED HEALTHCARE
TN4029085OtherBCBS TN