Provider Demographics
NPI:1356300792
Name:CHOCKALINGAM, SIVA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVA
Middle Name:KUMAR
Last Name:CHOCKALINGAM
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 1:1070 WILDEWOOD CTR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9740
Mailing Address - Country:US
Mailing Address - Phone:803-788-1100
Mailing Address - Fax:803-788-4522
Practice Address - Street 1:1070 WILDEWOOD CTR DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9740
Practice Address - Country:US
Practice Address - Phone:803-788-1100
Practice Address - Fax:803-788-4522
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC176712Medicaid
SCG66215Medicare UPIN
SC176712Medicaid