Provider Demographics
NPI:1699849927
Name:SHIVARAM, MARGANHALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGANHALLY
Middle Name:
Last Name:SHIVARAM
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 1:8767 BECCA PT
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1629
Mailing Address - Country:US
Mailing Address - Phone:901-758-3253
Mailing Address - Fax:901-797-8062
Practice Address - Street 1:8767 BECCA PT
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1629
Practice Address - Country:US
Practice Address - Phone:901-745-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG27207Medicare UPIN