Healthcare Provider Details

I. General information

NPI: 1699338012
Provider Name (Legal Business Name): AJAN SIVARAMAMOORTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1072
  • Fax:
Mailing address:
  • Phone: 919-966-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberSIVA-6Y7NJJ
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: