Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C1-0004534 | DE |
Y | 208600000X | Surgeon | C1-0004534 | DE |
N | 2086X0206X | Surgical Oncologist | 036130584 | IL |
NPI | 1114924735 |
---|---|
Provider Name | Dr. Magesh Sundaram |
First Address | Dover, DE 19901-3530 |
Second Address | Milford, DE 19963-4364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2005 |
Last Update Date | 08/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004733300 | (05) | MD |
1014359720001 | (05) | PA |
2598694 | (05) | OH |
36066 | NCI INVESTIGATOR ID (01) | |
3810003244 | (05) | WV |
64106016 | (05) | KY |
H17501 | (02) | WV |
P00266429 | RAILROAD MEDICARE (01) | WV |