MEDICARE: PREM P SIWAKOTI PA

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	363AM0700X	Medical Physician Assistant	50.007511RX	OH

General Provider Information

NPI Number	:	1841946738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREM P SIWAKOTI PA

Provider Business Mailing Address
First Line	:	6599 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1509
Country	:	US
Telephone Number	:	614-986-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	6599 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1509
Country	:	US
Telephone Number	:	614-986-7752
Fax Number	:

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

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/25/2023

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Directions to “ PREM P SIWAKOTI PA” Practice Location

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