Provider Demographics
NPI:1881684413
Name:SABUNDAYO, ROLENDO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLENDO
Middle Name:M
Last Name:SABUNDAYO
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 1:405 FREDERICK RD
Mailing Address - Street 2:STE 162
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-744-3553
Mailing Address - Fax:410-744-3586
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:STE 162
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-744-3553
Practice Address - Fax:410-744-3586
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD04832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W0717270OtherBCBS
B69722Medicare UPIN
7270Medicare ID - Type Unspecified