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NPI Code Detail

MEDICARE: BALAKRISHNAN SRIDHARAN MD

MEDICARE: BALAKRISHNAN SRIDHARAN MD
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
1207R00000XInternal Medicine Physician19265WV
2208M00000XHospitalist Physician19265WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00824219OTHERWVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881685550
Entity Type Code : Individual
Provider Name (Legal Business Name) : BALAKRISHNAN SRIDHARAN MD
Provider Business Mailing Address
First Line : 415 MORRIS ST
Second Line : SUITE 304
City : CHARLESTON
State : WV
Zip : 25301-1842
Country : US
Telephone Number : 304-388-7782
Fax Number : 304-388-7788
Provider Business Practice Location Address
First Line : 3200 MACCORKLE AVE SE
Second Line : HOSPITALISTS PROGRAM
City : CHARLESTON
State : WV
Zip : 25304-1227
Country : US
Telephone Number : 304-388-5848
Fax Number : 304-388-9654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 02/27/2013

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