Healthcare Provider Details

I. General information

NPI: 1992841399
Provider Name (Legal Business Name): DIVYA SRIKUMARAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIVYA GUPTA MD

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE JOHNS HOPKINS BAYVIEW MEDICAL CENTER
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 64481
BALTIMORE MD
21264-4481
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberP19723
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD69428
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: