Provider Demographics
NPI:1578501128
Name:SIVALINGAM, VARUNAN (MD)
Entity type:Individual
Prefix:DR
First Name:VARUNAN
Middle Name:
Last Name:SIVALINGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OLD MARLTON PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8772
Mailing Address - Country:US
Mailing Address - Phone:609-754-1770
Mailing Address - Fax:609-654-2320
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-657-1770
Practice Address - Fax:609-654-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06043700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ207W00000XOtherTAXONOMY
NJ207W00000XOtherTAXONOMY
NJ1972682797Medicare UPIN
NJ1306790001Medicare NSC
NJ034684Medicare PIN
PA169160Medicare PIN