Provider Demographics
NPI:1902055320
Name:SITARAMAN, KARTHIKEYAN (MD)
Entity Type:Individual
Prefix:
First Name:KARTHIKEYAN
Middle Name:
Last Name:SITARAMAN
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 1:1125 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1418
Mailing Address - Country:US
Mailing Address - Phone:415-456-9680
Mailing Address - Fax:415-213-4659
Practice Address - Street 1:1125 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:415-456-9680
Practice Address - Fax:415-213-4659
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC172080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03130398Medicaid
NYJ400005346Medicare PIN