Provider Demographics
NPI:1316938871
Name:NAGARKAR, SUMANT (MD)
Entity type:Individual
Prefix:DR
First Name:SUMANT
Middle Name:
Last Name:NAGARKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5475 E LA PALMA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:714-279-6368
Mailing Address - Fax:714-279-5811
Practice Address - Street 1:29472 AVENIDA DE LAS BANDERA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2651
Practice Address - Country:US
Practice Address - Phone:949-459-9968
Practice Address - Fax:949-766-2565
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG080038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G800380Medicaid
CA00G800380Medicaid
CAWG80038PMedicare ID - Type Unspecified