Provider Demographics
NPI:1235563339
Name:SIVA, PATRICK N (RN, RVT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:N
Last Name:SIVA
Suffix:
Gender:M
Credentials:RN, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 BISCAYNE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3403
Mailing Address - Country:US
Mailing Address - Phone:804-756-1300
Mailing Address - Fax:
Practice Address - Street 1:7811 BISCAYNE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3403
Practice Address - Country:US
Practice Address - Phone:804-747-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAV092090002471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00897450OtherRR MEDICARE
VAV09209000OtherLICENSE
VAP00897450OtherRR MEDICARE