Provider Demographics
NPI:1124001540
Name:SIVAKUMAR, USHA (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:SIVAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 SYCAMORE SPRING CT
Mailing Address - Street 2:
Mailing Address - City:COOKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21723-9304
Mailing Address - Country:US
Mailing Address - Phone:724-575-0126
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD82249207R00000X
PAMD068154L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000757350OtherBLUE CROSS BLUE SHIELD
PA1527667OtherGATEWAY
PA000000111557OtherTHREE RIVERS
PA032111RBFMedicare ID - Type Unspecified
PA000757350OtherBLUE CROSS BLUE SHIELD