Provider Demographics
NPI:1730133307
Name:SOMASUNDARAM, MANAMADURAI (MD)
Entity type:Individual
Prefix:DR
First Name:MANAMADURAI
Middle Name:
Last Name:SOMASUNDARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 PLAINSBORO RD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3030
Mailing Address - Country:US
Mailing Address - Phone:609-750-1521
Mailing Address - Fax:609-750-1523
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-750-1521
Practice Address - Fax:609-750-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 0651502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7642806Medicaid
NJ7642806Medicaid
NJG90956Medicare UPIN