Healthcare Provider Details

I. General information

NPI: 1699720508
Provider Name (Legal Business Name): SRINIVASA RAO MOVVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E WASHINGTON AVE
ATLANTIC HIGHLANDS NJ
07716-1327
US

IV. Provider business mailing address

37 E WASHINGTON AVE
ATLANTIC HIGHLANDS NJ
07716-1327
US

V. Phone/Fax

Practice location:
  • Phone: 783-291-3430
  • Fax: 732-291-5659
Mailing address:
  • Phone: 783-291-3430
  • Fax: 732-291-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA6591900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: