MEDICARE: PREMA SIVA 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	207R00000X	Internal Medicine Physician	186016	NY
2	207R00000X	Internal Medicine Physician	D66419	MD

General Provider Information

NPI Number	:	1699722009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMA SIVA MD

Provider Business Mailing Address
First Line	:	8871 GORMAN RD STE 300
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5877
Country	:	US
Telephone Number	:	410-498-3150
Fax Number	:	410-601-8886

Provider Business Practice Location Address
First Line	:	8871 GORMAN RD STE 300
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5877
Country	:	US
Telephone Number	:	410-498-3150
Fax Number	:	410-601-8886

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/04/2024

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Directions to “ PREMA SIVA MD” Practice Location

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