Healthcare Provider Details

I. General information

NPI: 1326155334
Provider Name (Legal Business Name): SADHASIVAM SITHANANDAM M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVE SUITE 380
TAKOMA PARK MD
20912-6384
US

IV. Provider business mailing address

7610 CARROLL AVE SUITE 380
TAKOMA PARK MD
20912-6384
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-6141
  • Fax: 301-891-6841
Mailing address:
  • Phone: 301-891-6141
  • Fax: 301-891-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number29518
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD29518
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier400651800
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: