Provider Demographics
NPI:1174576789
Name:ARYANGAT, SUKUMARAN C (MD)
Entity type:Individual
Prefix:
First Name:SUKUMARAN
Middle Name:C
Last Name:ARYANGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-2032
Mailing Address - Country:US
Mailing Address - Phone:301-927-3170
Mailing Address - Fax:301-927-0064
Practice Address - Street 1:3308 PERRY ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-2032
Practice Address - Country:US
Practice Address - Phone:301-927-3170
Practice Address - Fax:301-927-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD017221900Medicaid
DC15500001OtherCAREFIRST BLUE CROSS&BLUE
165113Medicare ID - Type Unspecified
B93877Medicare UPIN