Provider Demographics
NPI:1902153190
Name:GAUTAM SIRAM, MD, PC
Entity type:Organization
Organization Name:GAUTAM SIRAM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-785-4559
Mailing Address - Street 1:5530 WISCONSIN AVE STE 1660
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4322
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1660
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4322
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074565207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty