Healthcare Provider Details

I. General information

NPI: 1225340417
Provider Name (Legal Business Name): SRILATHA KOTHANDARAMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N WASHINGTON AVE SUITE 300
DALLAS TX
75246-1619
US

IV. Provider business mailing address

712 N WASHINGTON AVE SUITE 300
DALLAS TX
75246-1619
US

V. Phone/Fax

Practice location:
  • Phone: 214-823-6503
  • Fax: 214-826-0605
Mailing address:
  • Phone: 214-823-6503
  • Fax: 214-826-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberQ4792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: