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General NPI Number Information
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NPI Number | 1851324552
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Entity Type | Individual
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Provider Name | DASARATHY SRINIVAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1051 GAUSE BLVD STE 370
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City | SLIDELL
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State | LA
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Zip | 70458-2998
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Country | US
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Telephone | 985-280-4600
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Fax | 985-280-4642
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Provider Business Mailing Address
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Address Line | 1051 GAUSE BLVD STE 370
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City | SLIDELL
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State | LA
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Zip | 70458-2998
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Country | US
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Telephone | 985-280-4600
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Fax | 985-280-4642
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 05745R
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License Number State | LA
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