Provider Demographics
NPI:1811276553
Name:TANDON, INDER SUMRAT (MD)
Entity type:Individual
Prefix:DR
First Name:INDER
Middle Name:SUMRAT
Last Name:TANDON
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 1:9420 WILLEO RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6773
Mailing Address - Country:US
Mailing Address - Phone:470-267-1520
Mailing Address - Fax:
Practice Address - Street 1:9420 WILLEO RD STE 206
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6773
Practice Address - Country:US
Practice Address - Phone:470-267-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099097207R00000X
GA078477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003192075AMedicaid