Healthcare Provider Details

I. General information

NPI: 1699876367
Provider Name (Legal Business Name): SRINIVAS RAMARAO SHROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax: 334-260-4139
Mailing address:
  • Phone: 334-272-4670
  • Fax: 334-260-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number00010653
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00010653
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: