Provider Demographics
NPI:1952398588
Name:SIVARAMAN, PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:SIVARAMAN
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 1:1 CANDLEWICK DR
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1259
Mailing Address - Country:US
Mailing Address - Phone:975-588-4036
Mailing Address - Fax:973-628-7944
Practice Address - Street 1:1500 ALPS RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3635
Practice Address - Country:US
Practice Address - Phone:973-628-8500
Practice Address - Fax:973-628-7944
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902165Medicaid
SCN01480Medicaid
NC2046899Medicare PIN
NC5902165Medicaid