MEDICARE: DR. VARUNAN SIVALINGAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA06043700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207W00000X	OTHER	NJ	TAXONOMY

General Provider Information

NPI Number	:	1578501128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VARUNAN SIVALINGAM MD

Provider Business Mailing Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 203
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	609-754-1770
Fax Number	:	609-654-2320

Provider Business Practice Location Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 203
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	609-657-1770
Fax Number	:	609-654-2320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/06/2010

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