Provider Demographics
NPI:1427034107
Name:ANANDASIVAM, LOGANAYAKI (MD)
Entity Type:Individual
Prefix:
First Name:LOGANAYAKI
Middle Name:
Last Name:ANANDASIVAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 S PRICE RD
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2459
Mailing Address - Country:US
Mailing Address - Phone:956-548-2242
Mailing Address - Fax:956-548-2262
Practice Address - Street 1:64 S PRICE RD
Practice Address - Street 2:STE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2459
Practice Address - Country:US
Practice Address - Phone:956-548-2242
Practice Address - Fax:956-548-2262
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8593Medicare PIN
TXH77880Medicare UPIN