Provider Demographics
NPI:1902871239
Name:SUNDAR, SUMATHI (MD)
Entity Type:Individual
Prefix:
First Name:SUMATHI
Middle Name:
Last Name:SUNDAR
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 1:817 E BALTIMORE PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1929
Mailing Address - Country:US
Mailing Address - Phone:610-444-0113
Mailing Address - Fax:610-444-0744
Practice Address - Street 1:817 E BALTIMORE PIKE STE A
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1929
Practice Address - Country:US
Practice Address - Phone:610-444-0113
Practice Address - Fax:610-444-0744
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007776208000000X, 208D00000X
PAMD427867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1902871239Medicaid