Provider Demographics
NPI:1710096631
Name:SUNDARARAMAN, MICHAEL ANAND (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANAND
Last Name:SUNDARARAMAN
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 1:222 SOUTH HERLONG AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-329-6849
Mailing Address - Fax:803-985-4538
Practice Address - Street 1:222 SOUTH HERLONG AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-329-6849
Practice Address - Fax:803-985-4538
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-136392207P00000X
SC29596207P00000X
WV27168207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
I66972Medicare UPIN