Provider Demographics
NPI:1174663322
Name:EMANI, SITARAM MANOHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SITARAM
Middle Name:MANOHAR
Last Name:EMANI
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:FA-144
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-4104
Mailing Address - Fax:617-730-0214
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FA-144
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-4104
Practice Address - Fax:617-730-0214
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231571208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA90483OtherHPHC
MAJ41625OtherBCBS
MA496097OtherTUFTS
MA2144026Medicaid