MEDICARE: DR. BANGALORE S SRIDHARA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	213781	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00114326	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	961385	OTHER	NY	MVP/TACONIC IPA
2	193679	OTHER	NY	WELLCARE
3	213781	OTHER	NY	CONNECTICARE
4	213781	OTHER	NY	HIP
5	700608	OTHER	NY	US FAMILY HEALTH PLAN
6	2386215	OTHER	NY	AETNA HMO
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	58N891	OTHER	NY	EMPIRE BC STONY POINT
10	N67450	OTHER	NY	HEALTHNET
11	000000045698	OTHER	NY	GHI HMO
12	133693126	OTHER	NY	TAX ID #
13	P1979240	OTHER	NY	OXFORD
14	0181480	OTHER	NY	GHI PPO
15	58N892	OTHER	NY	EMPIRE BC WEST NYACK
16	7998110	OTHER	NY	AETNA PPO

General Provider Information

NPI Number	:	1063482636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BANGALORE S SRIDHARA MD

Provider Business Mailing Address
First Line	:	20 GRAND STREET, 3RD FL
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-942-1001
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	12 LIBERTY SQUARE MALL
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-2400
Country	:	US
Telephone Number	:	845-942-1001
Fax Number	:	845-942-1431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	01/11/2017

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