Healthcare Provider Details

I. General information

NPI: 1194991927
Provider Name (Legal Business Name): THARSAN SIVAKUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE
LEBANON NH
03756
US

IV. Provider business mailing address

928 PACIFIC ST APT C
NEW MILFORD NJ
07646-5314
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 201-483-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number13884
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: