Individual
DR. MAGESH SUNDARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14999 HEALTH CENTER DR STE 201, BOWIE, MD 20716-1087
(667) 214-1718
(410) 328-5147
Mailing address
PO BOX 64226, BALTIMORE, MD 21264-4226
(667) 214-1734
(410) 706-6976
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
C1-0004534
DE
2086X0206X
Surgical Oncology Physician
036130584
IL
2086X0206X
Surgical Oncology Physician
Primary
D0052627
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004733300
—
MD
05
—
1014359720001
—
PA
05
—
2598694
—
OH
01
—
36066
NCI INVESTIGATOR ID
—
05
—
3810003244
—
WV
05
—
64106016
—
KY
01
—
P00266429
RAILROAD MEDICARE
WV
Enumeration date
06/29/2005
Last updated
04/04/2023
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