Healthcare Provider Details

I. General information

NPI: 1164721676
Provider Name (Legal Business Name): SIDDHARTH AJAYBHAI SARAIYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL STE 102
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-1473
  • Fax:
Mailing address:
  • Phone: 419-383-4541
  • Fax: 419-383-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2020-01152
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.128783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: