Provider Demographics
NPI:1033734454
Name:AMUTHAN, SIDDARTH (MBBS)
Entity Type:Individual
Prefix:MR
First Name:SIDDARTH
Middle Name:
Last Name:AMUTHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY DOWNSTATE, 450 CLARKSON AVENUE
Mailing Address - Street 2:PEDIATRICS DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-270-4393
Mailing Address - Fax:718-613-8677
Practice Address - Street 1:SUNY DOWNSTATE, 450 CLARKSON AVENUE
Practice Address - Street 2:PEDIATRICS DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-4393
Practice Address - Fax:718-613-8677
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2022-02-08
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program