Provider Demographics
NPI:1003912338
Name:SIVA MD PA
Entity Type:Organization
Organization Name:SIVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RATNASABAPATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-369-5300
Mailing Address - Street 1:2845 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-369-5300
Mailing Address - Fax:352-369-5309
Practice Address - Street 1:2845 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-369-5300
Practice Address - Fax:352-369-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000WQOtherBCBS
FL270559100Medicaid
FL270559100Medicaid
FL000WQOtherBCBS
FLI15504Medicare UPIN