Provider Demographics
NPI:1932221223
Name:SANKARAN, DHARMASUMVARDHINI (MD)
Entity Type:Individual
Prefix:
First Name:DHARMASUMVARDHINI
Middle Name:
Last Name:SANKARAN
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 1:12881 GLENBERNIE LANE
Mailing Address - Street 2:
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3763
Mailing Address - Country:US
Mailing Address - Phone:314-434-4804
Mailing Address - Fax:
Practice Address - Street 1:22 MARR LANE
Practice Address - Street 2:
Practice Address - City:ST.CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-9000
Practice Address - Country:US
Practice Address - Phone:636-926-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9063208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA24673Medicare UPIN