Provider Demographics
NPI:1235583451
Name:SIVASAILAM, BARATHI
Entity Type:Individual
Prefix:
First Name:BARATHI
Middle Name:
Last Name:SIVASAILAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 COLUMBIA PIKE STE 400
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4462
Mailing Address - Country:US
Mailing Address - Phone:215-589-9012
Mailing Address - Fax:
Practice Address - Street 1:9711 MEDICAL CENTER DR STE 308
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3388
Practice Address - Country:US
Practice Address - Phone:301-251-1244
Practice Address - Fax:301-340-9360
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD87133207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology