Provider Demographics
NPI:1952390288
Name:BASKAR, SOUNDARAPANDIAN (MD)
Entity Type:Individual
Prefix:
First Name:SOUNDARAPANDIAN
Middle Name:
Last Name:BASKAR
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:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1345
Mailing Address - Country:US
Mailing Address - Phone:352-383-5200
Mailing Address - Fax:352-383-3534
Practice Address - Street 1:1703 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4307
Practice Address - Country:US
Practice Address - Phone:352-383-5200
Practice Address - Fax:352-383-3534
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93145207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273964000Medicaid
FL273964000Medicaid
FLU6466ZMedicare PIN
682960Medicare UPIN