Healthcare Provider Details

I. General information

NPI: 1336189836
Provider Name (Legal Business Name): TITTE R SRINIVAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TITTE RAJAGOPAL SRINIVAS

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-8500
  • Fax:
Mailing address:
  • Phone: 440-214-8026
  • Fax: 216-201-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number9843099-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35.090760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: