Provider Demographics
NPI:1295914653
Name:USHA SIVAKUMAR MD LLC
Entity type:Organization
Organization Name:USHA SIVAKUMAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-224-3530
Mailing Address - Street 1:415 E 4TH AVE
Mailing Address - Street 2:SUITE# 3
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1847
Mailing Address - Country:US
Mailing Address - Phone:724-224-3530
Mailing Address - Fax:724-224-3531
Practice Address - Street 1:415 E 4TH AVE
Practice Address - Street 2:SUITE# 3
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1847
Practice Address - Country:US
Practice Address - Phone:724-224-3530
Practice Address - Fax:724-224-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068154L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH05381Medicare UPIN