Healthcare Provider Details

I. General information

NPI: 1992189583
Provider Name (Legal Business Name): SRIRAM SANKARANARAYANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHRISTIANA CARE HEALTH SYSTEM 4755 OGLETOWN-STANTON RD, SUITE LE45
NEWARK DE
19718-0001
US

IV. Provider business mailing address

478 WASHINGTON AVE #1A
BROOKLYN NY
11238-1821
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1148
  • Fax:
Mailing address:
  • Phone: 347-909-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT209985
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: