Healthcare Provider Details

I. General information

NPI: 1225084155
Provider Name (Legal Business Name): PATTANAM DORAI SRINIVASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25400 US HIGHWAY 19 N STE 185
CLEARWATER FL
33763-2157
US

IV. Provider business mailing address

3740 EMBASSY CIR
PALM HARBOR FL
34685-1016
US

V. Phone/Fax

Practice location:
  • Phone: 954-417-8187
  • Fax:
Mailing address:
  • Phone: 727-474-6507
  • Fax: 765-450-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME124951
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME124951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: