Provider Demographics
NPI:1154368298
Name:SOOD, SANJIV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:
Last Name:SOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1389
Mailing Address - Country:US
Mailing Address - Phone:301-249-8440
Mailing Address - Fax:301-249-4033
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1389
Practice Address - Country:US
Practice Address - Phone:301-249-8440
Practice Address - Fax:301-249-4033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0037697207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE63775Medicare UPIN
MD549133Medicare ID - Type Unspecified