Basic Information
| Provider Information | |||||||||
| NPI: | 1851788954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANDASAMY | ||||||||
| FirstName: | SIVAVEERA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 S GREENE ST STE 319 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141734 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 W REDWOOD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212017003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141718 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA10797000 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | D0093659 | MD | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.