Basic Information
Provider Information | |||||||||
NPI: | 1336257666 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PATHMARAJAH | ||||||||
FirstName: | SIVANI | ||||||||
MiddleName: | S. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8050 BECKETT CENTER DR | ||||||||
Address2: | STE 108 | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450695017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5136187430 | ||||||||
FaxNumber: | 5132808868 | ||||||||
Practice Location | |||||||||
Address1: | 8050 BECKETT CENTER DR | ||||||||
Address2: | STE 108 | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450695017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5136187430 | ||||||||
FaxNumber: | 5132808868 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/27/2006 | ||||||||
LastUpdateDate: | 03/24/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35-088059 | OH | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | 35-088059 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 201035810 | 05 | IN |   | MEDICAID | P00428418 | 01 |   | RR MEDICARE | OTHER | 000000 519937 | 01 | OH | ANTHEM BCBS | OTHER | 000000520139 | 01 |   | BCBS FAIRFIELD HOS | OTHER | 2758225 | 05 | OH |   | MEDICAID | 7100188050 | 05 | KY |   | MEDICAID |