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General NPI Number Information
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NPI Number | 1639351422
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Entity Type | Organization
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Legal Business Name | SREENIVAS P VANGARA MD PA
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 5515 GULF DRIVE SUITE B
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652
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Country | US
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Telephone | 727-848-3995
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Fax | 727-843-9400
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Provider Business Mailing Address
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Address Line | 5515 GULF DRIVE SUITE B
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652
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Country | US
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Telephone | 727-848-3995
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Fax | 727-843-9400
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Authorized Official
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Title or Position | PRESIDENT
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Name | SREENIVAS P VANGARA
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Credential | MD
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Telephone | 727-848-3995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0073512
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License Number State | FL
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