Provider Demographics
NPI:1386700409
Name:SUNDARAM, SAVITRI (MD)
Entity type:Individual
Prefix:DR
First Name:SAVITRI
Middle Name:
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 US HIGHWAY 46 STE 101
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-328-7772
Mailing Address - Fax:973-361-0066
Practice Address - Street 1:195 US HIGHWAY 46 STE 101
Practice Address - Street 2:
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-328-7772
Practice Address - Fax:973-361-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA356812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06580Medicare UPIN
NJSU454409Medicare ID - Type Unspecified