Healthcare Provider Details

I. General information

NPI: 1457510059
Provider Name (Legal Business Name): SRIRAMAN RAM SRINIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BETHESDA METRO CTR STE 525
BETHESDA MD
20814-6424
US

IV. Provider business mailing address

19775 WILLOWDALE PL
ASHBURN VA
20147-5209
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-6000
  • Fax: 866-497-1239
Mailing address:
  • Phone: 917-769-1216
  • Fax: 866-497-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number332724
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number332724
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101243990
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD74074
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: