Provider Demographics
NPI:1013901172
Name:SIVAKUMAR, MAHALINGAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHALINGAM
Middle Name:
Last Name:SIVAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 SELWYN AVE
Mailing Address - Street 2:MILSTEIN BLDG 5A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7626
Mailing Address - Country:US
Mailing Address - Phone:719-960-1320
Mailing Address - Fax:718-960-1051
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:ACN MORRIS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-960-1320
Practice Address - Fax:718-960-1051
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2224302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134256Medicaid
NY004I51Medicare ID - Type Unspecified
NY02134256Medicaid