Provider Demographics
NPI:1699722009
Name:SIVA, PREMA (MD)
Entity type:Individual
Prefix:
First Name:PREMA
Middle Name:
Last Name:SIVA
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 1:8871 GORMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5877
Mailing Address - Country:US
Mailing Address - Phone:410-498-3150
Mailing Address - Fax:410-601-8886
Practice Address - Street 1:8871 GORMAN RD STE 300
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5877
Practice Address - Country:US
Practice Address - Phone:410-498-3150
Practice Address - Fax:410-601-8886
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186016207R00000X
MDD66419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY86F771Medicare ID - Type Unspecified
NYE95182Medicare UPIN