Healthcare Provider Details

I. General information

NPI: 1417985854
Provider Name (Legal Business Name): SRILATHA KANUMURU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

IV. Provider business mailing address

5354 AMBROSIA DR
ELLICOTT CITY MD
21043-6862
US

V. Phone/Fax

Practice location:
  • Phone: 410-336-0124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0064539
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: