Provider Demographics
NPI:1336252766
Name:SUNTHARAM, SAROJA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SAROJA
Middle Name:
Last Name:SUNTHARAM
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 1:3512 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-375-8004
Mailing Address - Fax:
Practice Address - Street 1:720 SW 2ND AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-375-6755
Practice Address - Fax:352-374-8186
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38014Medicare ID - Type Unspecified
FLE34768Medicare UPIN