Provider Demographics
NPI:1447223227
Name:SIVANANDAM, ESWARI A (MD)
Entity Type:Individual
Prefix:
First Name:ESWARI
Middle Name:A
Last Name:SIVANANDAM
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 1:630 E RIVER ST
Mailing Address - Street 2:4TH FLOOR PATHOLOGY DEPT
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5902
Mailing Address - Country:US
Mailing Address - Phone:440-329-7656
Mailing Address - Fax:
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:ATTN LAB DEPT
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-960-3216
Practice Address - Fax:440-244-0726
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039137207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0575211Medicaid
A80655Medicare UPIN
OH0575211Medicaid
OH7011522Medicare ID - Type Unspecified