Provider Demographics
NPI:1922409671
Name:VIMALENDRAN, SUTHAHARAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SUTHAHARAN
Middle Name:
Last Name:VIMALENDRAN
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 1:6846 BUCKLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4264
Mailing Address - Country:US
Mailing Address - Phone:315-410-6400
Mailing Address - Fax:315-410-6410
Practice Address - Street 1:6846 BUCKLEY ROAD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4264
Practice Address - Country:US
Practice Address - Phone:315-410-6400
Practice Address - Fax:315-410-6410
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272376-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology