Healthcare Provider Details

I. General information

NPI: 1598099376
Provider Name (Legal Business Name): JANARDHAN SRINIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

2232 WILBORN AVE STE A
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8977
  • Fax: 434-572-2510
Mailing address:
  • Phone: 434-572-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101248603
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: