=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225084155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATTANAM DORAI SRINIVASAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2006
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4738 GRAND BLVD STE G
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-5170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-474-6507
-----------------------------------------------------
Fax | 765-450-6161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 EMBASSY CIR
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-474-6507
-----------------------------------------------------
Fax | 765-450-6161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | ME124951
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | ME124951
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------