Provider Demographics
NPI:1467493239
Name:KEDARNATH, SIVASUBRAMANIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVASUBRAMANIAM
Middle Name:
Last Name:KEDARNATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIVA
Other - Middle Name:
Other - Last Name:KEDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:124 HOME DEPOT DR STE D
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-8002
Mailing Address - Country:US
Mailing Address - Phone:814-432-7327
Mailing Address - Fax:814-437-6225
Practice Address - Street 1:124 HOME DEPOT DR STE D
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-8002
Practice Address - Country:US
Practice Address - Phone:814-432-7327
Practice Address - Fax:814-437-6225
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043417E207RC0000X, 207RC0000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001531594OtherHIGHMARK
PA1485523Medicaid
PAE64044Medicare UPIN
PA1485523Medicaid
PA133432Medicare PIN