Individual
DR. DHAMAYANTHI SIVAMOHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1428 N GARDNER ST, SCOTTSBURG, IN 47170-7751
(812) 752-4001
(812) 752-4654
Mailing address
1428 N GARDNER ST, SCOTTSBURG, IN 47170-8720
(812) 752-4001
(855) 550-0556
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055482A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200368350
—
IN
Enumeration date
09/20/2006
Last updated
03/07/2019
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