Provider Demographics
NPI:1811971922
Name:SAMBANDAM, SUNDARESAN T (MD)
Entity type:Individual
Prefix:
First Name:SUNDARESAN
Middle Name:T
Last Name:SAMBANDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:1220 PONTIAC AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4456
Practice Address - Country:US
Practice Address - Phone:401-943-4660
Practice Address - Fax:401-943-0240
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI05372207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001994OtherBLUECHIP/RIBCBS
005372OtherTUFTS HP
720024001OtherCIGNA
RI0007390OtherTRICARE
0513005OtherUS HEALTHCARE
RI0000002589OtherBC/BS OF RI
RI30-00050OtherUHC OF NE,INC
4549333OtherAETNA
MA0173690Medicaid
RI7003434Medicaid
RI2376OtherNEIGHBORHOOD HEATH PLAN
9475RIHOtherHARVARD PILGRIM HP
0513005OtherUS HEALTHCARE
MA0173690Medicaid
RI30-00050OtherUHC OF NE,INC