Individual
MAMATHA SIRIVOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
350 N COX ST STE 28, ASHEBORO, NC 27203-5514
(336) 629-6500
(336) 629-9500
Mailing address
43 WHITING HILL RD STE 300, BREWER, ME 04412-1006
(207) 973-5035
(207) 973-5042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2024-00275
NC
207Q00000X
Family Medicine Physician
57322-20
WI
207Q00000X
Family Medicine Physician
MD21574
ME
Other
Enumeration date
05/21/2009
Last updated
06/04/2024
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