Provider Demographics
NPI:1750373882
Name:KANABAR, SUDHIN (MD)
Entity type:Individual
Prefix:
First Name:SUDHIN
Middle Name:
Last Name:KANABAR
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 1:130 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9516
Mailing Address - Country:US
Mailing Address - Phone:802-371-4100
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4100
Practice Address - Fax:513-793-1032
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077505 K2084N0400X
VT042.00166332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500731OtherUNITED HEALTH CARE
OH2254297Medicaid
OH000000206778OtherANTHEM
OH130024101OtherRAILROAD MEDICARE
OH7193269OtherAETNA
OH0500731OtherUNITED HEALTH CARE
OH130024101OtherRAILROAD MEDICARE