Healthcare Provider Details

I. General information

NPI: 1053480640
Provider Name (Legal Business Name): SIVA THIAGARAJAH, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY STE 190
CHARLOTTESVILLE VA
22911-8835
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY STE 190
CHARLOTTESVILLE VA
22911-8835
US

V. Phone/Fax

Practice location:
  • Phone: 434-220-8620
  • Fax: 434-220-8625
Mailing address:
  • Phone: 434-220-8620
  • Fax: 434-220-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET WILLIS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 434-249-3186