Provider Demographics
NPI:1104848761
Name:VEMANA, SIVA RAMAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVA
Middle Name:RAMAIAH
Last Name:VEMANA
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 1:420 ABERFELDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504
Mailing Address - Country:US
Mailing Address - Phone:937-325-1634
Mailing Address - Fax:937-717-0411
Practice Address - Street 1:420 ABERFELDA DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504
Practice Address - Country:US
Practice Address - Phone:937-325-1634
Practice Address - Fax:937-717-0411
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0389173Medicaid
VE0454584Medicare ID - Type Unspecified
A77854Medicare UPIN