Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 13607 | NH |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 13607 | NH |
NPI | 1053363176 |
---|---|
Provider Name | Malathy T Sundaram |
First Address | Rochester, NH 03867-3235 |
Second Address | Rochester, NH 03867-3235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 30/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262401188 | (05) | ME |
H95977 | (02) | ME |