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General NPI Number Information
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NPI Number | 1245361583
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Entity Type | Organization
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Legal Business Name | SRISAI GOWDA MD LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 2106 NEW ROAD D-8
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City | LINWOOD
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State | NJ
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Zip | 08221
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Country | US
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Telephone | 609-927-1030
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Fax | 609-927-9985
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Provider Business Mailing Address
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Address Line | 2106 NEW ROAD D-8
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City | LINWOOD
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State | NJ
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Zip | 08221
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Country | US
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Telephone | 609-927-1030
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Fax | 609-927-9985
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Authorized Official
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Title or Position | OWNER
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Name | DR. SRISAI GOWDA
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Credential | M.D.
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Telephone | 609-927-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA06553300
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License Number State | NJ
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