Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | MD438146 | PA |
N | 208200000X | Surgeon | 2016-00513 | NC |
N | 208600000X | Surgeon | 2016-00513 | NC |
Y | 208200000X | Surgeon | 267143 | MA |
Y | 208600000X | Surgeon | 267143 | MA |
NPI | 1083948384 |
---|---|
Provider Name | Dr. Madhu Siddeswarappa |
First Address | Plymouth, MA 02360-2237 |
Second Address | Plymouth, MA 02360-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 17/03/2018 |