Provider Demographics
NPI:1245816271
Name:SHANKAR, SIDDHARTH (MD)
Entity type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:
Last Name:SHANKAR
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 1:10506B MONTGOMERY RD STE 407
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4489
Mailing Address - Country:US
Mailing Address - Phone:513-793-2077
Mailing Address - Fax:513-793-4523
Practice Address - Street 1:10506B MONTGOMERY RD STE 407
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4489
Practice Address - Country:US
Practice Address - Phone:513-793-2077
Practice Address - Fax:513-793-4523
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35151377208M00000X
OH390200000X
OH35.151377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program