Healthcare Provider Details

I. General information

NPI: 1144259433
Provider Name (Legal Business Name): SRINIVAS RAO DUKKIPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST 3RD FLOOR
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1030
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4029
  • Fax:
Mailing address:
  • Phone: 212-241-4029
  • Fax: 212-876-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME0101875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: