Healthcare Provider Details

I. General information

NPI: 1588623953
Provider Name (Legal Business Name): VENKATRAMAN SRINIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 PACIFIC AVE STE B
NATRONA HEIGHTS PA
15065-2145
US

IV. Provider business mailing address

1624 PACIFIC AVE STE B
NATRONA HEIGHTS PA
15065-2145
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-3345
  • Fax: 724-226-2415
Mailing address:
  • Phone: 724-226-3345
  • Fax: 724-226-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD021497E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD021497E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: