Provider Demographics
NPI:1972572824
Name:SUNDER, RAJAGOPAL KEERTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAGOPAL
Middle Name:KEERTHY
Last Name:SUNDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEERTHY
Other - Middle Name:
Other - Last Name:SUNDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3060 EL CERRITO PLZ
Mailing Address - Street 2:SUITE 266
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-4011
Mailing Address - Country:US
Mailing Address - Phone:510-685-2022
Mailing Address - Fax:
Practice Address - Street 1:17853 SANTIAGO BLVD STE 107
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-4199
Practice Address - Country:US
Practice Address - Phone:510-685-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA942232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101426267Medicaid
PA095723NBZMedicare ID - Type Unspecified
PA101426267Medicaid