Healthcare Provider Details

I. General information

NPI: 1801944632
Provider Name (Legal Business Name): SRINIVAS CHANNAPRAGADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 GREEN HILL RD
SPRINGFIELD NJ
07081-3615
US

IV. Provider business mailing address

43 GREEN HILL RD
SPRINGFIELD NJ
07081-3615
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-0829
  • Fax: 908-522-0849
Mailing address:
  • Phone: 908-522-0829
  • Fax: 908-522-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA05830600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: