Individual
SIVAMAINTHAN VITHIANANTHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
195 COLLYER ST, SUITE 302, PROVIDENCE, RI 02904-1869
(401) 793-5140
(401) 793-5171
Mailing address
PO BOX 16149, RUMFORD, RI 02916-0697
(401) 453-9625
(401) 435-7069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
80634
MA
208600000X
Surgery Physician
MD12377
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02109373
—
NY
Enumeration date
09/23/2005
Last updated
04/20/2021
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