NPIMap

Individual provider Active NPI

Sundaravadivel Loganathan, MD

  • Internal Medicine Physician
  • Dover, NH
National Provider Identifier
1396298022
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19532 Issued in NH
Practice address
789 Central Ave
Dover, NH 03820-2526
Phone
(603) 740-2503
Fax
(603) 740-2497
NPI assigned
Jul 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 267908 MA
Internal Medicine Physician 207R00000X 19532 NH Primary

Addresses

Primary practice location

789 Central Ave
Dover, NH 03820-2526

Mailing address

789 Central Ave
Dover, NH 03820-2526

Other identifiers 1

IdentifierTypeStateIssuer
3118203MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, ME2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190802001476 NH Practitioner - Internal Medicine 4880973577 Reassigns benefits to 1 organization
I20240319000506 ME Practitioner - Internal Medicine 4880973577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
York HospitalGroup PAC ID 6406766781, 202 clinicians

Practice addresses (Care Compare)

15 Hospital Dr
York, ME 03909-1011
Phone (207) 363-4321

789 Central Ave
Dover, NH 03820-2526
Phone (603) 740-2503

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
York Hospital CurrentSince Apr 1, 2024 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jul 15, 2019 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jul 15, 2019 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients
Wentworth Douglass Hospital Past Accepting new patients

Locations

15 Hospital Dr
York, ME 03909
Phone (207) 351-2478

789 Central Ave
#2
Dover, NH 03820
Phone (603) 740-2503

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

Interoperability endpoints

  • Direct secure messaging: loganathan.sundaravadivel.wdh@direct.partners.masshiway.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1396298022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "603-740-2503",
            "fax_number": "603-740-2497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGANATHAN",
        "first_name": "SUNDARAVADIVEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-29",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "267908",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "19532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3118203",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.