Provider Demographics
NPI:1053363176
Name:SUNDARAM, MALATHY T (MD)
Entity type:Individual
Prefix:
First Name:MALATHY
Middle Name:T
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 ROCHESTER HILL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3235
Mailing Address - Country:US
Mailing Address - Phone:207-850-1079
Mailing Address - Fax:207-324-0911
Practice Address - Street 1:60 ROCHESTER HILL RD STE 7
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3235
Practice Address - Country:US
Practice Address - Phone:207-850-1079
Practice Address - Fax:207-324-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13607207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME262401188Medicaid
ME262401188Medicaid
MEME0202Medicare PIN