Provider Demographics
NPI:1689612111
Name:SIVARAMAN, VADIVELU (MD)
Entity Type:Individual
Prefix:DR
First Name:VADIVELU
Middle Name:
Last Name:SIVARAMAN
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:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:410-328-6720
Mailing Address - Fax:410-328-6174
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 300 6TH FL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-6720
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54750207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCA8702OtherRAILROAD MEDICARE GROUP
MDCA8702OtherRAILROAD MEDICARE GROUP
MDG96495Medicare UPIN
MD118ZMedicare PIN
MD518YMedicare PIN