Healthcare Provider Details

I. General information

NPI: 1104890920
Provider Name (Legal Business Name): SIVA R MURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COLEGATE DR EMERGENCY DEPT
MARIETTA OH
45750-1323
US

IV. Provider business mailing address

PO BOX 449 ATTN: PROVIDER ENROLLMENT
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35050136
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35050136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: