Provider Demographics
NPI:1336257666
Name:PATHMARAJAH, SIVANI S (MD)
Entity Type:Individual
Prefix:
First Name:SIVANI
Middle Name:S
Last Name:PATHMARAJAH
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 1:8050 BECKETT CENTER DR
Mailing Address - Street 2:STE 108
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5017
Mailing Address - Country:US
Mailing Address - Phone:513-618-7430
Mailing Address - Fax:513-280-8868
Practice Address - Street 1:8050 BECKETT CENTER DR
Practice Address - Street 2:STE 108
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5017
Practice Address - Country:US
Practice Address - Phone:513-618-7430
Practice Address - Fax:513-280-8868
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088059208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035810Medicaid
P00428418OtherRR MEDICARE
OH000000 519937OtherANTHEM BCBS
000000520139OtherBCBS FAIRFIELD HOS
OH2758225Medicaid
KY7100188050Medicaid
KY7100188050Medicaid
OHH006260Medicare PIN