Active NPI
Sukumar Balachandran, D.M.D
- Endodontics
- Lutherville, MD
National Provider Identifier
1871520130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 12052
- Practice address
- 2328 W Joppa Rd
Suite 102
Lutherville, MD 21093-4612 - Phone
- (410) 296-8050
- Fax
- (410) 296-8052
- NPI assigned
- Jun 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 12052 | MD | Primary |
Addresses
Primary practice location
2328 W Joppa Rd
Suite 102
Lutherville, MD 21093-4612
Mailing address
6103 Westcliff Dr
Baltimore, MD 21209-3535
Phone (410) 542-0533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406000874 | MD | Order and Referring Only - Other (Physician) | 5799083838 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12052 | MD | MD | Endodontist |
| 10061 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontics, P.a. | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Endodontics
- Lutherville, MD
- NPI 1407969033
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871520130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6103 WESTCLIFF DR",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212093535",
"telephone_number": "410-542-0533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2328 W JOPPA RD",
"address_2": "SUITE 102",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "210934612",
"telephone_number": "410-296-8050",
"fax_number": "410-296-8052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALACHANDRAN",
"first_name": "SUKUMAR",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MD",
"license": "12052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lutherville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.