Provider Demographics
NPI:1548423494
Name:THANAWALA, SIDDHARTHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDDHARTHA
Middle Name:S
Last Name:THANAWALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1514 SHERIDAN RD
Mailing Address - Street 2:APT 2308
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324
Mailing Address - Country:US
Mailing Address - Phone:443-722-4639
Mailing Address - Fax:404-712-7957
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-4583
Practice Address - Fax:404-712-7957
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2022-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0610092085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology