Healthcare Provider Details

I. General information

NPI: 1558606814
Provider Name (Legal Business Name): APOORVA SRIVASTAVA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 KELLY BLVD
SLIPPERY ROCK PA
16057-8523
US

IV. Provider business mailing address

621 KELLY BLVD PO BOX 143
SLIPPERY ROCK PA
16057-8523
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-4009
  • Fax: 724-794-4099
Mailing address:
  • Phone: 724-794-4009
  • Fax: 724-794-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS017087
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: