Provider Demographics
NPI:1235234212
Name:SIVANANDY, MALA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MALA
Middle Name:S
Last Name:SIVANANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:GRYZMISH 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-1769
Mailing Address - Fax:617-667-7060
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:GRYZMISH 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-1769
Practice Address - Fax:617-667-7060
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35088569207R00000X
MA239636207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686937Medicaid
OHI62458Medicare UPIN
OH2686937Medicaid