Provider Demographics
NPI:1376364018
Name:SIAMASHVILI, MAKA (MD, MBA, PA-C)
Entity type:Individual
Prefix:DR
First Name:MAKA
Middle Name:
Last Name:SIAMASHVILI
Suffix:
Gender:F
Credentials:MD, MBA, PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3409 TEWKESBURY RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1095
Mailing Address - Country:US
Mailing Address - Phone:615-715-9494
Mailing Address - Fax:
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant