Provider Demographics
NPI:1932498367
Name:SUNDARAM, DEEPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:SUNDARAM
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 1:2600 NETHERLAND AVE
Mailing Address - Street 2:APT 1014
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4801
Mailing Address - Country:US
Mailing Address - Phone:347-541-2711
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE
Practice Address - Street 2:APT 1014
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4801
Practice Address - Country:US
Practice Address - Phone:347-541-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program