Healthcare Provider Details

I. General information

NPI: 1609818269
Provider Name (Legal Business Name): SRINIVAS BOPPANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E OAK HILL AVE
KNOXVILLE TN
37917-4522
US

IV. Provider business mailing address

PO BOX 16506
CHAPEL HILL NC
27516-6506
US

V. Phone/Fax

Practice location:
  • Phone: 865-545-7817
  • Fax: 865-545-8649
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: