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General NPI Number Information
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NPI Number | 1346416559
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Entity Type | Individual
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Provider Name | SRINIVAS KETHARAJU MD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 3 LYON PL
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City | OGDENSBURG
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State | NY
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Zip | 13669-2590
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Country | US
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Telephone | 315-713-6700
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Fax | 866-816-0815
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Provider Business Mailing Address
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Address Line | 330 MOUNT AUBURN ST # 2
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5597
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Country | US
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Telephone | 781-893-5550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 43564
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 1016377
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 280458
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License Number State | NY
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