Healthcare Provider Details

I. General information

NPI: 1003091000
Provider Name (Legal Business Name): SRINIVAS PATHAPATI, MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 PLUM CREEK DR
AMARILLO TX
79124-1602
US

IV. Provider business mailing address

PO BOX 9467
BELFAST ME
04915-9467
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-9820
  • Fax: 806-467-9743
Mailing address:
  • Phone: 806-467-9820
  • Fax: 806-467-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SRINIVAS PATHAPATI
Title or Position: MD
Credential:
Phone: 806-467-9820