MEDICARE: SRINIVAS PAVULURI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25MA07341500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255360020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVAS PAVULURI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 71
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-0071
Country	:	US
Telephone Number	:	732-264-4300
Fax Number	:	732-264-1102

Provider Business Practice Location Address
First Line	:	1 BETHANY RD STE 91
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1669
Country	:	US
Telephone Number	:	732-264-4300
Fax Number	:	732-264-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	06/23/2022

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