Healthcare Provider Details

I. General information

NPI: 1033438437
Provider Name (Legal Business Name): VALAPARAMBIL K. SIVAN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD SUITE 214
BALTIMORE MD
21237-4329
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-238-0101
  • Fax: 410-238-0944
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: VALAPARAMBIL K. SIVAN
Title or Position: OWNER
Credential: M.D.
Phone: 410-335-0008