Provider Demographics
NPI:1033676143
Name:USHA SIVAKUMAR MD LLC
Entity Type:Organization
Organization Name:USHA SIVAKUMAR MD LLC
Other - Org Name:SIVIMED INTERNAL MEDICINE ASSOCIATES ND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-228-9123
Mailing Address - Street 1:141 THOMAS JOHNSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4509
Mailing Address - Country:US
Mailing Address - Phone:301-228-9123
Mailing Address - Fax:855-760-5009
Practice Address - Street 1:141 THOMAS JOHNSON DR STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4509
Practice Address - Country:US
Practice Address - Phone:301-228-9123
Practice Address - Fax:855-760-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1053193193OtherBOARD OF NURSING