Provider Demographics
NPI:1326155334
Name:SITHANANDAM, SADHASIVAM (MD,)
Entity Type:Individual
Prefix:DR
First Name:SADHASIVAM
Middle Name:
Last Name:SITHANANDAM
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 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-6141
Mailing Address - Fax:301-891-6841
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-6141
Practice Address - Fax:301-891-6841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD295182080A0000X
MDD29518208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400651800Medicaid