Healthcare Provider Details

I. General information

NPI: 1215902937
Provider Name (Legal Business Name): SIVA RAMACHANDRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHESTERBROOK BLVD FL 3
BERWYN PA
19312-3805
US

IV. Provider business mailing address

1001 CHESTERBROOK BLVD FL 3
BERWYN PA
19312-3805
US

V. Phone/Fax

Practice location:
  • Phone: 610-576-7600
  • Fax:
Mailing address:
  • Phone: 610-576-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD063569L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD063569L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD063569L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: