Healthcare Provider Details

I. General information

NPI: 1447632336
Provider Name (Legal Business Name): MATHAVAN SIVARAJAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

6778 GEORGETOWN LN
MADISON OH
44057-2173
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2568
  • Fax:
Mailing address:
  • Phone: 216-387-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.134019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: