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General NPI Number Information
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NPI Number | 1356494405
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Entity Type | Individual
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Provider Name | SHANTANU SRINIVASAN KIDAMBI MD
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Gender | Male
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Dates
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Enumeration Date | 01/20/2007
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY
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City | WORCESTER
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State | MA
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Zip | 01655-0002
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Country | US
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Telephone | 508-334-3271
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Fax | 508-856-5911
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Provider Business Mailing Address
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Address Line | PO BOX 415348
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 047523
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME94938
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | P4663
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 33123
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 226541
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License Number State | MA
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