Provider Demographics
NPI:1679597280
Name:SUNDERAM, DARSHI (MD)
Entity type:Individual
Prefix:DR
First Name:DARSHI
Middle Name:
Last Name:SUNDERAM
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 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-266-9111
Mailing Address - Fax:973-266-1227
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-266-9111
Practice Address - Fax:973-266-1227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04656000207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1885006Medicaid
NJ1885006Medicaid
NJG63519Medicare UPIN