Healthcare Provider Details

I. General information

NPI: 1922028307
Provider Name (Legal Business Name): SIVARAMA PRASAD SOMPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 RIDGE RD
REISTERSTOWN MD
21136-5625
US

IV. Provider business mailing address

2222 RIDGE RD
REISTERSTOWN MD
21136-5625
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8000
  • Fax:
Mailing address:
  • Phone: 410-225-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0016163
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: