Provider Demographics
NPI:1245551779
Name:SIVENDRAN, MEERA (MD)
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:SIVENDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SPRUCE ST
Mailing Address - Street 2:2 MALONEY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6144
Mailing Address - Country:US
Mailing Address - Phone:610-902-2400
Mailing Address - Fax:610-902-2404
Practice Address - Street 1:145 KING OF PRUSSIA ROAD
Practice Address - Street 2:SUITE 306 SOUTH
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4557
Practice Address - Country:US
Practice Address - Phone:610-902-2400
Practice Address - Fax:610-902-2404
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09474400207N00000X
PAMD469050207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology