Healthcare Provider Details

I. General information

NPI: 1013177641
Provider Name (Legal Business Name): SREENIVAS GARLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE RADIOLOGY DEPT
ALBANY NY
12208-3412
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 203
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3277
  • Fax: 518-262-4210
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number281696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: