Provider Demographics
NPI:1730124884
Name:SUNDAR, VIJAYA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:SUNDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7419
Mailing Address - Country:US
Mailing Address - Phone:205-348-1770
Mailing Address - Fax:205-348-5160
Practice Address - Street 1:850 5TH AVE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7419
Practice Address - Country:US
Practice Address - Phone:205-348-1770
Practice Address - Fax:205-348-5160
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14597Medicaid
ALC74189Medicare UPIN
AL14597Medicare ID - Type Unspecified