Provider Demographics
NPI:1689820789
Name:SIRIPURAM, SANDHYA (MD)
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:
Last Name:SIRIPURAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDHYA
Other - Middle Name:
Other - Last Name:GOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2555 COURT DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-834-4390
Mailing Address - Fax:704-834-3274
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 270
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-834-4390
Practice Address - Fax:704-834-3274
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910595Medicaid
NC5910595Medicaid
NC2023090Medicare PIN