MEDICARE: SIVA MARAN M.D.

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	MD0000023962	TN
2	207RG0100X	Gastroenterology Physician	023962	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3159757	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619965043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVA MARAN M.D.

Provider Business Mailing Address
First Line	:	705 N HIGH ST
Second Line	:	SUITE A
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3876
Country	:	US
Telephone Number	:	423-415-3310
Fax Number	:	423-587-9898

Provider Business Practice Location Address
First Line	:	705 N HIGH ST
Second Line	:	SUITE A
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3876
Country	:	US
Telephone Number	:	423-415-3310
Fax Number	:	423-587-9898

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	09/04/2020

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