Healthcare Provider Details

I. General information

NPI: 1922326552
Provider Name (Legal Business Name): ARUN SRINIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 EAST PENN SQUARE THE WANAMAKER BUILDING 9TH FL
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2708
  • Fax: 267-425-9552
Mailing address:
  • Phone: 267-425-9538
  • Fax: 267-425-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD446501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: