Healthcare Provider Details

I. General information

NPI: 1669646477
Provider Name (Legal Business Name): SREEDEVI KURELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/21/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1484
US

IV. Provider business mailing address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1484
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7908
  • Fax: 301-754-7324
Mailing address:
  • Phone: 301-754-7908
  • Fax: 301-754-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301078251
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD039828
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: