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General NPI Number Information
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NPI Number | 1659688224
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Entity Type | Individual
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Provider Name | SRINIVAS S BOMMIREDDIPALLI M.D
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Gender | Male
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 207 FOOTE AVE WCA HOSPITAL
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City | JAMESTOWN
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State | NY
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Zip | 14701
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Country | US
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Telephone | 301-618-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 207 FOOTE AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-7077
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Country | US
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Telephone | 301-221-0034
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 272799
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License Number State | NY
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